August 2024: The Food and Drug Administration has granted approval for the use of durvalumab (Imfinzi, AstraZeneca) in combination with platinum-containing chemotherapy as a neoadjuvant treatment, followed by single-agent durvalumab as an adjuvant treatment after surgery.
This treatment is specifically intended for adults with resectable non-small cell lung cancer (NSCLC) who have tumors that are at least 4 cm in size and/or have positive lymph nodes. It is important to note that this treatment is only recommended for patients who do not have known epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements.
Safety and Efficacy
The effectiveness of the treatment was assessed in the AEGEAN clinical trial (NCT03800134), which was a study involving 802 patients with previously untreated and surgically removable squamous or non-squamous NSCLC (Stage IIA to select Stage IIIB [AJCC, 8th edition]). The experiment was conducted in many centers and followed a randomized, double-blind, placebo-controlled design.
Participants were randomly assigned in equal numbers to receive either durvalumab or placebo, along with platinum-based chemotherapy, every 3 weeks for a maximum of 4 cycles as a neoadjuvant treatment. This was followed by either continuous treatment with durvalumab alone or placebo, every 4 weeks for a maximum of 12 cycles as an adjuvant treatment.
The primary measures of effectiveness were event-free survival (EFS) as assessed by an independent review board, and pathological complete response (pCR) as assessed by a central pathology review board. The median event-free survival (EFS) was not determined (95% CI: 31.9, not estimable [NE]) in the durvalumab group and was 25.9 months (95% CI: 18.9, NE) in the placebo group (hazard ratio 0.68 [95% CI: 0.53, 0.88]; p-value=0.0039).
The rate of pathological complete response (pCR) was 17% (95% confidence interval [CI]: 13, 21) in the durvalumab arm and 4.3% (95% CI: 2.5, 7) in the placebo arm. During the prespecified interim analyses, the statistical significance of overall survival (OS) was not officially assessed. However, a descriptive analysis showed no evident negative impact.
The predominant adverse effects (≥20%) included anemia, nausea, constipation, exhaustion, musculoskeletal pain, and rash. Among the patients who were administered neoadjuvant durvalumab, 1.7% experienced adverse responses that prevented them from undergoing surgery, whereas only 1% in the placebo group faced the same issue.
The recommended dosage of durvalumab for patients weighing 30 kg or more is 1,500 mg every 3 weeks for neoadjuvant treatment and every 4 weeks for adjuvant treatment. The recommended dosage of durvalumab for patients weighing less than 30 kg is 20 mg/kg. Prior to administering chemotherapy on the same day, it is recommended to administer Durvalumab.
