Lancet oncology|。 Comparison of the effects of the first-line Durvalumab combined therapy for broad-stage small cell lung cancer

Breast cancer surpassed lung cancer for the first time as the world's most common cancer, accounting for about 11.7% of new cancer cases, according to the latest global cancer burden report released in 2020 by the International Agency for Research on Cancer (IARC), part of the World Health Organization.
, lung cancer accounts for 18% of all cancer deaths as the leading cause of cancer deaths.
of these cases, extensive-stage small cell lung cancer (ES-SCLC) accounts for about two-thirds of small cell lung cancer (small cell lung cancer, SCLC), a highly invasive and rapidly worsening form of lung cancer.
ES-SCLC treatment is usually based on chemotherapy, auxiliary radiotherapy and other comprehensive treatment.
that although ES-SCLC has an initial response to chemotherapy, it usually relapses, highlighting the urgent need for new treatments.
last September, AstraZeneca's Durvalumab was approved by the European Union to treat adult patients with ES-SCLC in the first line with a variety of chemotherapy drugs.
in the CASPIAN PHASE III clinical trial, imfinzi combined chemotherapy first-line therapy showed significant overall lifetime (OS) benefits (13.0 months vs. 10.3 months) and an increase in objective remission rates (68 percent vs. 58 percent) compared to chemotherapy alone.
recently, the International CASPIAN Research Group reported the latest developments in the durvalumab joint treatment ES-SCLC.
results were published on Lancet Oncology.
CASPIAN is an ongoing, open-label, randomized Phase 3 trial conducted at 209 cancer treatment centers in 23 countries around the world.
included in the study were over 18 years of age, untreated, histologically tested as ES-SCLC, who was rated O or 1 by WHO.
Using an interactive voice response or network response system, patients were randomly assigned (1:1:1) to 6 subgroups based on platinum use, and intravenous durvalumab plus tremelimumab plus platinum - etoposide, durvalumab plus platinum - etoposide or single platinum - etoposide therapy.
patients in all groups were treated with etoposide 80-100mg/m2 on the 1-3rd day of each cycle.
the platinum-eposide group received up to 6 cycles of platinum-eposide therapy every 3 weeks and had the option of preventive cranial radiotherapy (at the researcher's discretion).
immunotherapy group received 4 cycles of platinum-etoposide plus durvalumab 1500 mg plus or no tremelimumab 75 mg, once every 3 weeks, and then every 4 weeks durvalumab 1500 mg maintenance treatment.
two main endpoints are the total lifetime (OS) of patients with three treatments in the intended treatment population.
safety was evaluated in all patients who received at least one treatment.
2017.03.27-2018.05.29, 972 patients were screened and 805 patients were randomly assigned (268 patients received durvalumab plus tremelimumab plus platinum-etoposide, 268 patients received durvalumab plus platinum-eposide, and 269 patients received platinum-eposide).
as of 2020.01.27, the mid-level follow-up time was 25.1 months.
OS showed no significant improvement compared to Durvalumab plus tremelimumab plus platinum-eposide and platinum-eposide, with a medium OS of 10.4 months and 10.5 months.
the continuous improvement of OS compared to Durvalumab plus platinum-eposide and platinum-eposide (HR -0.75), with a medium total lifetime of 12.9 and 10.5 months, respectively.
of these, the most common adverse events were a reduction in neutral granulocytes (85 cases (32 per cent), 64 cases (24 per cent), 88 cases (33 per cent) and anemia (34 cases (13 per cent), 24 cases (9 per cent) and 48 cases (18 per cent).
three groups of heavy adverse events were 121 (45%), 85 (32%) and 97 (36%).
In addition, there were 12 treatment-related deaths (5%) in the three groups (death, fever-neutral granulocyte reduction and pulmonary embolism, each by 2; enteritis, general deterioration of general health and multi-organ dysfunction syndrome, pneumonia, pneumonia and hepatitis, respiratory failure and sudden death by 1 each), and 6 cases (2%) (cardiac arrest).
Dehydration, hepatotoxicity, interstitiric pulmonary disease, pan-blood cell reduction and sepsis were 1) and 2 cases (1%) (pan-blood cell reduction and plate reduction disorders.
addition, the overall survival rate of the first-line durvalumab plus platinum-eposide and platinum-epoposide continued to improve, but there was no significant improvement compared with the addition of tremelimumab and platinum-etoposide on the basis of durvalumab plus etoposide.
these results support the use of durvalumab plus platinum-etoposide as a new standard for first-line treatment of ES-SCLC.
: Goldman JW, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. 2020 Dec 4:S1470-2045 (20) 30539-8. MedSci Original Source: MedSci Original Copyright Notice: All Noted on this website Source: Metz Medical or "Source: MedSci Original" text, images and audio-visual materials, copyrighted by Metz Medical, are not authorized, and may not be reproduced by any media, website or individual, and shall be authorized to be reproduced with the words "Source: Metz Medicine".
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