Consolidation durvalumab after cCRT shows decreased disease progression in LS-SCLC
Prof Suresh Senan - University Medical Centers, Amsterdam, The Netherlands
The ELCC study was a presentation on the ADRIATIC trial which is an ongoing phase III double-blinded randomised trial in patients with limited stage small cell lung cancer whose disease had not progressed after concurrent chemoradiotherapy, either with or without prophylactic brain radiation.
Patients were randomised to one of three arms: durvalumab alone for 24 months, placebo, or the combination of durvalumab and tremelimumab. At the first interim analysis significant improvement in overall survival and progression free survival was observed for the durvalumab versus placebo arm. In this ELCC presentation I presented a post-hoc analysis of recurrence patterns, the first recurrence patterns, assessed by blinded independent central review, for patients in these two study arms.
What were the results of this study?
Intrathoracic progression was defined as any lesions within the lung and mediastinum and although intrathoracic only recurrences were comparable – about 28-29% in both the durvalumab and placebo arms – extrathoracic only recurrences were much lower in the durvalumab arm – 18% versus 25%. The absence of progression was similar in both arms, significantly, the time to first progression or death by location deferred. Time to intrathoracic progression or death was 37.3 months in the durvalumab arm and nearly 10 months less, 27.6, in the placebo arm with a hazard ratio of 0.82. Time to extrathoracic progression or death was more marked with a hazard ratio of 0.67 and most recurrences manifested as a single organ, particularly in the brain. Patients with both durvalumab and prophylactic brain irradiation had only less than 3% incidence of brain relapses as opposed to 11% if they got durvalumab but no prophylactic brain irradiation. Patients who had neither durvalumab or brain radiation had nearly a 19.5% incidence of brain relapses.
What do you think is the clinical significance of these results?
These findings show that durvalumab was well tolerated and significantly reduced the incidence of extrathoracic relapses in patients undergoing consolidation treatment after completion of chemoradiotherapy either with or without prophylactic brain radiation. It also shows that durvalumab reduces recurrence of brain relapses in patients receiving prophylactic brain radiation and also those without prior prophylactic brain radiation. It confirms that prophylactic brain radiation reduces brain relapses irrespective of the durvalumab treatment arm.
Is there anything else you would like to add?
These data further support the use of consolidation durvalumab as a new standard of care for patients with limited stage small cell lung cancer who have not progressed after concurrent chemoradiotherapy.
