Loading
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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
805 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survivalprimary | Durvalumab + EP | 268 | 13 months | 0.73 (0.59 to 0.91) | 0.0047 | link |
| EP alone | 269 | 10.3 months | ||||
| 3-year overall survival rate | Durvalumab + EP | - | 17.6% | - | - | link |
| EP alone | - | 5.8% |
A second publication from the CASPIAN trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
Immunotherapy is now part of first-line treatment for extensive-stage small-cell lung cancer everywhere, on the strength of a gain measured in weeks. The size of that gain is the reason small-cell lung cancer remains the clearest unmet need in thoracic oncology.
Shares CREST: consolidation thoracic radiotherapy in extensive-stage small-cell lung cancer, CAPSTONE-1, Platinum + etoposide (EP / CE), Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN).
Shares CAPSTONE-1, Platinum + etoposide (EP / CE), Extensive-stage small-cell lung cancer, Small-cell lung cancer.
Shares Extensive-stage small-cell lung cancer, Durvalumab, AstraZeneca, Small-cell lung cancer.
Shares Extensive-stage small-cell lung cancer, Durvalumab, AstraZeneca, Small-cell lung cancer.
Shares Tremelimumab, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Tremelimumab, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Tremelimumab, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Tremelimumab, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.