Perioperative durvalumab in non-small-cell lung cancer

A perioperative immunotherapy with durvalumab plus neoadjuvant chemotherapy has been associated with significantly higher event-free survival and pathological complete response in patients with resectable non-small-cell lung cancer (NSCLC), as shown by results from the AEGEAN trial recently published on The New England Journal of Medicine.
In this phase III trial, 802 patients with resectable NSCLC were randomized to receive platinum-based chemotherapy plus durvalumab or placebo administered intravenously every 3 weeks for 4 cycles before surgery, followed by adjuvant durvalumab or placebo intravenously every 4 weeks for 12 cycles. Results showed a significantly longer duration of event-free survival in the durvalumab arm: at the 12-month analysis, event-free survival was observed in 73.4% of the patients who received durvalumab as compared with 64.5% of the patients who received placebo. The incidence of pathological complete response was significantly greater with durvalumab than with placebo (17.2% vs. 4.3%) and both benefits, i.e. event-free survival and pathological complete response, were observed regardless of disease stage and PD-L1 expression; adverse events, that led to discontinuation of durvalumab in 12% of patients, were consistent with drug profile. «Results from the AEGEAN trial reinforce the importance of perioperative treatment approaches that combine the benefits of neoadjuvant and adjuvant immunotherapy, priming antitumor immunity while the primary tumor and lymph nodes are present, and eradicating residual micrometastases before and after surgery. Our findings show a clear clinical benefit with perioperative immunotherapy in patients with resectable NSCLC. On the basis of the current findings, perioperative durvalumab plus neoadjuvant chemotherapy should be considered as a potential new treatment option for patients with resectable NSCLC», authors conclude. Future efforts must determine which patients may benefit from neoadjuvant therapy alone and which patients may benefit from additional adjuvant immunotherapy.