Imfinzi Boosts Lung Cancer Outcomes, But Some Patients Are Not Given the Drug

Certain patient characteristics may lead to lower rates of receiving Imfinzi in non-small cell lung cancer, research noted.

Imfinzi (durvalumab), when given after chemoradiotherapy, improved survival outcomes in patients with unresectable stage 3 non-small cell lung cancer (NSCLC), confirming that the regimen should be standard of care for most patients in this population.

However, certain patient characteristics — such as race, age and geographic region — were associated with lower rates of receiving the drug, according to the SPOTLIGHT study published in JAMA.

“I would love to see an increased adoption of this agent, knowing that we are certainly seeing a sustained benefit in real-world cohorts,” study author, Dr. Meghan Mooradian, medical oncologist at Massachusetts General Hospital in Boston, said in an interview with CURE®.

Imfinzi Improves Outcomes

Mooradian and colleagues analyzed data from patients with unresectable stage 3 NSCLC who were treated with chemoradiotherapy: 332 received Imfinzi after chemoradiotherapy, while 88 did not. Of note, all patients were treated in the real-world setting, meaning that none of the patients were treated on a clinical trial.

Findings showed that the median time to the next therapy or death and the time to distant metastasis (cancer spreading to far-away parts of the body) or death both were not reached in the Imfinzi arm. This means that not enough patients experienced these outcomes for the researchers to calculate an average. Meanwhile, the median time to next therapy or death was 8.3 months in the non-Imfinzi arm and time to distance metastasis or death was 11.3 months.

Patients who received Imfinzi also tended to have better survival outcomes. The median progression-free survival, which describes the length of time patients live without their disease worsening, was not reached in the Imfinzi group and 17.5 months in the non-Imfinzi group. Overall survival, which is the time patients live before death of any cause, was 19.4 months in the Imfinzi group and 7.6 months in the non-Imfinzi group.

These findings were consistent with those of the PACIFIC trial, which led to the 2018 approval of Imfinzi for locally advanced NSCLC that was treated with chemoradiotherapy.

“Overall, when we look at our patient cohort, it really does mirror what we saw in the PACIFIC clinical trial,” Moordian said. “In my mind, that really affirms the role of [Imfinzi] in patients with unresectable NSCLC who have completed definitive chemotherapy and radiotherapy.”

Mooradian explained that there were some demographic differences observed between the groups of patients who did and did not receive Imfinzi. There was a higher rate of patients who were living in the south and/or African American in the group that did not receive Imfinzi. Patients who did receive Imfinzi tended to be younger and be more independent in their ability to perform daily tasks.

Mooradian did mention that there are certain patient characteristics — such as the presence of an autoimmune disease — that may make immunotherapy agents like Imfinzi not the best option. However, that patient data was not available to the team of researchers on the SPOTLIGHT study.

Clinician Discussions Can Ensure the Best Treatment

That said, Mooradian encouraged patients — and the clinicians treating them — to have upfront conversations before the start of therapy so that individuals know what to expect, and how long their treatment may take.

Before Imfinzi is administered, patients go through “an intensive eight to 12 weeks of chemotherapy plus radiation,” according to Mooradian. After those finish, if patients expect to be done with treatment, they may be taken aback with the thought of another year of Imfinzi treatment, if not warned beforehand.

“Having that education upfront is key. That’s hopefully something that providers — both medical oncologists and the radiation oncologists — are doing,” Mooradian said.

Additionally, patients can be their own advocate and not shy away from obtaining a second opinion.

“I always tell patients — whether I’m seeing them for a second opinion or in any other realm — that physicians and treatment teams just want you to feel well cared for. So if, by chance, there’s something that’s making you feel like that’s not happening, you’re not getting the information you need or someone is not delivering it in a way you understand, it’s important to seek out other options or potentially communicate with providers and say, ‘This is what I need from you. How can you help me achieve that?’” Mooradian said.

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