It is the rarest and most aggressive lung cancer. The “small cell” one, also called microcytoma, for which there has been little possibility of a cure for a long time. Now, new data from the Caspian clinical trial, presented at the European Congress of Medical Oncology (ESMO 2021), show a sustained and clinically significant benefit in the overall survival of patients with extended stage disease after three years of treatment with the combination of chemotherapies. and durvalumab immunotherapy.
SPECIAL ESMO 2021
Small cell lung cancer and new treatment options
In 2020, in Italy, approximately 41,000 new cases of lung cancer were estimated, of which over 6,000 are microcytomas (SCLC). It is a particularly aggressive neoplasm characterized by rapid progression despite an initial response to chemotherapy. Durvalumab – in combination with etoposide and carboplatin or cisplatin – is currently approved for the first-line treatment of extended stage small cell lung cancer in more than 55 countries, including those in the European Union. In fact, as early as June 2019, the Caspian study had shown to improve overall survival, with a reduction in the relative risk of death of 27% compared to chemotherapy alone. The update of these data was then presented a year later, during the 2020 Asco Congress, with a median follow-up of over two years.
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Now, recent results have shown lasting efficacy at a follow-up of more than three years, with a 29% reduction in the risk of death. The updated median overall survival was 12.9 months versus 10.5 months for chemotherapy alone. An estimated 17.6% of patients treated with durvalumab plus chemotherapy were alive at three years, compared with 5.8% of patients treated with chemotherapy alone, and benefits were seen in all patient subgroups. This is the longest survival update reported for immunotherapy treatment in this stage of the disease.
“Patients with extended stage SCLC have limited treatment options and still have a poor prognosis; this makes particularly significant the data showing that three times more patients survive three years with durvalumab treatment plus chemotherapy than chemotherapy alone “, explains Filippo de Marinis (Director of the Division of Thoracic Oncology IEO, European Institute of Oncology, di Milano): “These results confirm that treatment with durvalumab in combination with platinum-based chemotherapy represents an important standard of care in this population”.
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The disease in the extended stage
About two-thirds of patients with microcytoma are diagnosed with extended stage disease (ES-SCLC), in which the cancer has spread widely through the lung or to other parts of the body. The prognosis is particularly poor as, based on data available prior to the approval of immunotherapy regimens for ES-SCLC, only 7% of patients with SCLC and 3% of those with extended stage disease are alive for five years. after diagnosis. “This dramatic improvement in three-year survival in patients with extended stage SCLC is an unprecedented result,” comments Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca. the search for new therapeutic options that are able to transform the outcomes of the disease in the various stages, not only with the CASPIAN study in extended disease, but also with the ADRIATIC study, in the limited stage “.
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Trials for limited forms and other cancers
Durvalumab is also being investigated as a post-chemo-radiotherapy (CRT) treatment in patients with limited-stage small cell lung cancer in the ADRIATIC study. In addition, durvalumab is approved for the treatment of non-small cell lung cancer (NSCLC) with curative intent of unresectable Stage III disease, following chemo-radiotherapy, based on PACIFIC results. In the development program, the drug is being studied as monotherapy and in combination with other anti-cancer treatments in NSCLC, SCLC, bladder cancer, hepatocellular carcinoma, biliary tract cancer (a type of liver cancer), esophageal cancer, cancer gastric and gastroesophageal cancer, cervical cancer, ovarian cancer, endometrial cancer and other solid tumors.
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