{"entity":{"id":"dream3r","kind":"trial","name":"DREAM3R","aka":[],"tldr":"The phase 3 test of durvalumab with chemotherapy was stopped early and did not meet its goal, despite an encouraging earlier study.","summary":"DREAM3R, trial NCT04334759 sponsored by ALTG and PrECOG and reported in 2026, was the phase 3 test of durvalumab with platinum and pemetrexed as first-line treatment for unresectable pleural mesothelioma, and it was stopped early without meeting its primary overall survival endpoint despite an encouraging single-arm predecessor. It followed the DREAM and PrE0505 phase 2 studies, whose signals it did not confirm, with medians and hazard ratio pending publication after presentation at ESMO 2025. OnCo links it to mesothelioma, durvalumab, pemetrexed and Anna K. Nowak. Together with the modest effect in IND.227 it suggests the chemo-immunotherapy benefit in mesothelioma is real but small and histology-dependent, so first-line immunotherapy in the disease now rests on CheckMate 743 and IND.227.","status":"negative","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT04334759","url":"https://clinicaltrials.gov/study/NCT04334759"},{"label":"2026 trial landscape (MesoWatch)","url":"https://mesowatch.org/news/2026/03/mesothelioma-clinical-trial-results-compared/"}],"tags":["lesson:single-arm-to-phase-3"],"related":[],"cancers":["mesothelioma"],"sections":[],"technologies":["checkpoint-inhibitor"],"targets":[],"drugs":["durvalumab","pemetrexed"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["anna-nowak"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT04334759","phase":"3","setting":"Unresectable pleural mesothelioma, first line: durvalumab + platinum-pemetrexed vs chemotherapy","sponsor":"ALTG / PrECOG","result":"Stopped early; primary endpoint not met.","started":"2021-02-18","startedType":"actual","yearReported":2026,"enrolledBasis":"registry","outcomes":[{"endpoint":"Overall survival","primary":true,"unit":"months","arms":[{"name":"Durvalumab + platinum-pemetrexed","note":"Trial closed early; primary OS endpoint not met at the analysis presented at ESMO 2025. Medians and hazard ratio pending publication."},{"name":"Platinum-pemetrexed"}],"source":"https://clinicaltrials.gov/study/NCT04334759"}],"replication":"Did not confirm the single-arm PrE0505 and DREAM phase 2 signals; chemo-immunotherapy in mesothelioma rests on the ipilimumab-nivolumab (CheckMate 743) and IND.227 pembrolizumab data instead."},"route":"/trials/dream3r/","neighbours":{"cancer":[{"id":"mesothelioma","kind":"cancer","name":"Mesothelioma","route":"/cancers/mesothelioma/"}],"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":"pemetrexed","kind":"drug","name":"Pemetrexed","route":"/drugs/pemetrexed/"}],"person":[{"id":"anna-nowak","kind":"person","name":"Anna K. Nowak","route":"/people/anna-nowak/"}],"term":[{"id":"data-monitoring-committee","kind":"term","name":"Data monitoring committee (DSMB, IDMC)","route":"/terms/data-monitoring-committee/"},{"id":"futility","kind":"term","name":"Futility analysis (stopped for futility)","route":"/terms/futility/"},{"id":"sample-size-re-estimation","kind":"term","name":"Statistical power, sample size and re-estimation","route":"/terms/sample-size-re-estimation/"},{"id":"trial-failure-modes","kind":"term","name":"Why trials fail: underpowered, wrong endpoint, control arm drift, subgroup fishing, crossover","route":"/terms/trial-failure-modes/"}]}}