{"entity":{"id":"caspian","kind":"trial","name":"CASPIAN","aka":[],"tldr":"Confirmed that adding a PD-L1 blocker to first-line chemotherapy helps in small-cell lung cancer, and showed that adding a second immunotherapy did not help further.","summary":"CASPIAN, trial NCT03043872 sponsored by AstraZeneca and reported in 2019, confirmed that adding the PD-L1 antibody durvalumab to first-line platinum and etoposide helps in extensive-stage small-cell lung cancer, and showed that adding the CTLA-4 antibody tremelimumab did not help further. It randomised 805 patients, met its primary overall survival endpoint for durvalumab plus chemotherapy with a durable minority alive at three years, allowed cisplatin or carboplatin and up to six chemotherapy cycles in the control arm, and led to FDA approval in March 2020. OnCo links it to small-cell lung cancer, durvalumab, tremelimumab, the platinum-etoposide record, Luis Paz-Ares and CAPSTONE-1, and the result is consistent with IMpower133 while the failure of the CTLA-4 add-on was itself replicated by other attempts. Why only a minority gain durable benefit remains the open question.","status":"positive","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03043872","url":"https://clinicaltrials.gov/study/NCT03043872"}],"tags":[],"related":[],"cancers":["sclc","extensive-stage-sclc"],"sections":[],"technologies":["checkpoint-inhibitor"],"targets":[],"drugs":["durvalumab","tremelimumab","platinum-etoposide"],"companies":["astrazeneca"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["luis-paz-ares"],"bottlenecks":[],"keyPapers":["paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019","paper-caspian-lancet-oncol-2021-update"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT03043872","phase":"3","setting":"First-line extensive-stage SCLC: platinum-etoposide + durvalumab (± tremelimumab) vs platinum-etoposide","sponsor":"AstraZeneca","result":"OS 13.0 vs 10.3 months, HR 0.73; 3-year OS 17.6% vs 5.8%.","started":"2017-03-27","startedType":"actual","yearReported":2019,"enrolled":805,"enrolledBasis":"registry","outcomes":[{"endpoint":"Overall survival","primary":true,"unit":"months","arms":[{"name":"Durvalumab + EP","n":268,"value":13},{"name":"EP alone","n":269,"value":10.3}],"hr":0.73,"ci":[0.59,0.91],"p":"0.0047","source":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32222-6/fulltext"},{"endpoint":"3-year overall survival rate","unit":"%","arms":[{"name":"Durvalumab + EP","value":17.6},{"name":"EP alone","value":5.8}],"source":"https://doi.org/10.1016/S0140-6736(19)32222-6"}],"replication":"Consistent with IMpower133; the durvalumab-tremelimumab arm's failure was itself replicated by other CTLA-4 add-on attempts in SCLC."},"route":"/trials/caspian/","neighbours":{"cancer":[{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"}],"drug":[{"id":"durvalumab","kind":"drug","name":"Durvalumab","route":"/drugs/durvalumab/"},{"id":"platinum-etoposide","kind":"drug","name":"Platinum + etoposide (EP / CE)","route":"/drugs/platinum-etoposide/"},{"id":"tremelimumab","kind":"drug","name":"Tremelimumab","route":"/drugs/tremelimumab/"}],"company":[{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"}],"person":[{"id":"luis-paz-ares","kind":"person","name":"Luis Paz-Ares","route":"/people/luis-paz-ares/"}],"paper":[{"id":"paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019","kind":"paper","name":"Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN)","route":"/key-papers/paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019/"},{"id":"paper-caspian-lancet-oncol-2021-update","kind":"paper","name":"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","route":"/key-papers/paper-caspian-lancet-oncol-2021-update/"}],"trial":[{"id":"capstone-1","kind":"trial","name":"CAPSTONE-1","route":"/trials/capstone-1/"},{"id":"crest-thoracic-rt","kind":"trial","name":"CREST: consolidation thoracic radiotherapy in extensive-stage small-cell lung cancer","route":"/trials/crest-thoracic-rt/"}]}}