Non-Small Cell Lung Cancer Coverage from Every Angle

First-Line Immunotherapy Combination in Lung Cancer

By: Joseph Fanelli
Posted: Wednesday, January 2, 2019

Although statistical significance was not achieved, first-line immunotherapy with durvalumab demonstrated “clinically meaningful” improvements in overall survival compared with chemotherapy in patients with non–small cell lung cancer (NSCLC), according to Naiyer Rizvi, MD, of Columbia University Medical Center, and colleagues. These results from the MYSTIC open-label phase III trial (Abstract LBA6) were reported at the European Society for Medical Oncology (ESMO) Immuno-Oncology Congress in Geneva.

“The analysis shows that appropriate biomarkers are needed to select the patients most likely to benefit from combination immunotherapy in first line,” said Pilar Garrido, MD, PhD, of Ramón y Cajal University Hospital, Madrid, said in an ESMO press release. “The challenge now is to prospectively validate them prior to implementation in clinical practice.”

Researchers enrolled 1,118 patients with metastatic NSCLC, who were randomly assigned to receive durvalumab, durvalumab plus tremelimumab, or chemotherapy. Efficacy findings were presented for the 488 patients with a PD-L1 tumor cell greater than or equal to 25%.

Patients in the durvalumab monotherapy group had an overall survival of 16.3 months versus 12.9 months with chemotherapy and 11.9 months with durvalumab and tremelimumab. The proportion of those with a high tumor mutational burden alive at 2 years was 39% with durvalumab plus tremelimumab, 30% with durvalumab alone, and 18% with chemotherapy. As for those with a low tumor mutational burden, overall survival favored durvalumab alone at 12.2 months, compared with 8.5 months with durvalumab plus tremelimumab and 11.6 months with chemotherapy.

As for toxicity,  grade 3 or 4 treatment-related adverse events were reported in 14.6%, 22.1%, and 33.8% of those in the durvalumab monotherapy, durvalumab plus tremelimumab, and chemotherapy, respectively.

Disclosure: The study authors’ disclosure information may be found at Annals of Oncology.

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