Durvalumab in Advanced Lung Cancer: Final Overall Survival Data From ATLANTIC Trial
Posted: Friday, September 4, 2020
Final overall survival data from the phase II ATLANTIC trial suggest that durvalumab has significant clinical activity in patients with heavily pretreated non–small cell lung cancers (NSCLCs), including patients with EGFR-positive/ALK-positive tumors. Naiyer A. Rizvi, MD, of Columbia University Medical Center in New York, and colleagues published these findings in Lung Cancer.
This phase II trial recruited 444 patients with stage IIIB/IV NSCLC who had disease progression after treatment with at least two different systemic regimens. Patients received intravenous durvalumab every 2 weeks for up to 12 months. Patients were divided into three cohorts: cohort 1 had EGFR-positive/ALK-positive NSCLC (n=111); cohort 2 had EGFR-negative/ALK-negative tumors (n=265); and cohort 3 had EGFR-negative/ALK-negative tumors with more than 90% of tumor cells staining for PD-L1 (n=68). In cohort 1, 77 patients had more than 25% of tumor cells expressing PD-L1; in cohort 2, 149 and 94 patients had 25% and less than 25% of tumor cells expressing PD-L1, respectively.
At the time of the data cutoff, 73.9% of patients enrolled in the study had died, with 93.3% of those deaths resulting from disease progression alone. The median overall survival was 13.3 months among patients in cohort 1 who had more than 25% of tumor cells expressing PD-L1, compared with 10.9 months in cohort 2 and 13.2 months in cohort 3. For patients in cohorts 1 and 2 who had less than 25% of tumor cells expressing PD-L1, the median overall survival was 9.9 months and 9.3 months, respectively. The 12- and 24-month overall survival rates were similarly higher in patients who had higher PD-L1 expression, irrespective of EGFR/ALK status.
Approximately one-third of patients experienced treatment-related adverse events, the most common being dermatitis, hypothyroidism, rash, diarrhea, and hyperthyroidism. Grade 3 or 4 adverse events occurred in 9.5% of patients, and serious side effects were seen in 6.3% of patients. The most common grade 3 treatment side effects included pneumonitis, diarrhea, and infusion reactions.
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