The New England Journal of MedicineDurvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer

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The phase 3 ADRIATIC trial demonstrates significant improvements in overall survival and progression-free survival with adjuvant durvalumab therapy compared to placebo in patients with limited-stage small-cell lung cancer who did not progress after concurrent chemoradiotherapy. This study marks the first major advancement in systemic treatment for this patient population in three decades, potentially establishing a new standard of care.

Key Points:

• Adjuvant durvalumab significantly improved overall survival compared to placebo (median 55.9 months vs. 33.4 months; hazard ratio for death, 0.73; P=0.01).
• Progression-free survival was also significantly longer with durvalumab (median 16.6 months vs. 9.2 months; hazard ratio for progression or death, 0.76; P=0.02).
• Three-year overall survival rates were 56.5% with durvalumab vs. 47.6% with placebo.
• The safety profile of durvalumab was consistent with its established profile, with a higher incidence of immune-mediated adverse events compared to placebo (32.1% vs. 10.2%).
• Benefits were observed regardless of previous thoracic radiotherapy schedule or use of prophylactic cranial irradiation.
• The study included 730 patients randomized to receive durvalumab, durvalumab plus tremelimumab, or placebo for up to 24 months.
• Results for the durvalumab plus tremelimumab arm remain blinded pending further analysis.

HCN Medical Memo
The ADRIATIC trial results suggest that adjuvant durvalumab therapy could become a new standard of care for patients with limited-stage small-cell lung cancer who have not progressed after chemoradiotherapy, offering a significant improvement in overall survival and progression-free survival.

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