First-Line Durvalumab Plus Platinum-Doublet Chemotherapy Prolongs Survival for Patients With Extensive-Stage Small Cell Lung Cancer

According to results from a real-world comparison study, first-line durvalumab plus platinum-doublet chemotherapy prolonged survival compared to first-line atezolizumab plus platinum-doublet chemotherapy among patients with extensive-stage small cell lung cancer (SCLC). 

“Programmed death ligand-1 (PD-L1) immune checkpoint inhibitors (ICIs) are preferred first-line treatments in combination with chemotherapy with both atezolizumab and durvalumab being equivalent options,” stated Megan Vince, MD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, and coauthors. “Although both ICIs are listed as front-line options in clinical guidelines, there have been no head-to-head trials comparing durvalumab to atezolizumab.” 

In this retrospective study, 101 patients who received at least 2 prior cycles of chemotherapy with immune checkpoint inhibition and 1 prior cycle of maintenance immune checkpoint inhibition were assigned to receive either first-line atezolizumab (n = 46) or durvalumab (n = 55) plus platinum-doublet chemotherapy. The primary end point was overall survival (OS). Key secondary end points included progression-free survival (PFS), immune-related adverse events, and PFS on second-line therapy. 

At analysis, median OS was 11.6 months in the atezolizumab arm and 14.7 months in the durvalumab arm (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.38 to 0.92; P = .020). Median PFS was 5.9 months and 6.3 months, respectively (P = .020). Immune-related adverse events occurred in 47.8% of patients in the atezolizumab arm and 32.7% of patients in the durvalumab arm (P = .344) and led to hospitalization in 36.4% of patients and 16.7% of patients, respectively (P = .204). PFS on second-line therapy was 2.3 months in the atezolizumab arm and 3.4 months in the durvalumab arm (HR, 1.24; 95% CI, 0.69 to 2.23; P = .466). 

As Dr Vince et al concluded, “durvalumab was associated with improved overall survival in patients with extensive-stage small cell lung cancer consistent with previous findings from a similar study in a Chinese patient population.” 

Source: 

Vince M, Naqvi SMH, Pellini B, et al. Real-world comparison of the efficacy and safety of atezolizumab versus durvalumab in extensive-stage small cell lung cancer. Lung Cancer. Published online: October 25, 2024. doi: 10.1016/j.lungcan.2024.10799