First-line immunotherapy does not improve survival in metastatic lung cancer

Research has shown that current first-line immunotherapy fails to extend survival in non small-cell lung carcinoma, compared with chemotherapy

Micrograph of non small cell lung carcinoma

Neither single nor combination first-line immunotherapy significantly extends survival, compared with chemotherapy, in metastatic non small-cell lung carcinoma (NSCLC), trial results published in Annals of Oncology (17 December 2018) have shown[1]

In the phase III trial, 1,118 treatment-naive patients were randomly assigned to durvalumab, durvalumab plus tremelimumab, or chemotherapy. Of these, 488 patients had tumour cell expression of the receptor PD-L1 of ≥25%, indicating that they were more likely to respond to immunotherapy. 

Among these patients, median overall survival was greater with first-line durvalumab alone at 16.3 months versus 12.9 months for chemotherapy alone; however, it should be noted that while the authors described this as “clinically meaningful”, it did not reach statistical significance.

There was no significant difference in overall survival between durvalumab plus tremelimumab and chemotherapy, nor in progression-free survival between any of the treatment arms.

Immunotherapy is increasingly being used first line in NSCLC and some patients may prefer to avoid chemotherapy owing to its side effects.

The researchers said that, in future, identification of biomarkers could help target patients who will benefit the most from first-line immunotherapy.

“Further analyses are ongoing,” they said, reporting their findings at the European Society for Medical Oncology Immuno-oncology Congress in Geneva, Switzerland.


[1] Rizvi N, Chul Cho B, Reinmuth N et al. Durvalumab with or without tremelimumab vs platinum-based chemotherapy as first-line treatment for metastatic non-small cell lung cancer: MYSTIC. Presented at: ESMO Immuno-Oncology Congress; 13 December 2018; Geneva, Switzerland. Annals of Oncology 2018;29(Suppl 10). doi: 10.1093/annonc/mdy511.005

Last updated
Clinical Pharmacist, CP, February 2019, Vol 11, No 2;11(2):DOI:10.1211/PJ.2019.20205974

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