Summary
Perioperative IMFINZI® + neoadjuvant CT is a new treatment option for patients with resectable NSCLC irrespective of PD-L12,3
Efficacy
- First perioperative regimen approved in Switzerland to describe the benefit of perioperative immunotherapy + neoadjuvant CT1–3
- Significant improvement in EFS: 31% reduction in the risk of disease progression or death3
- Clinically meaningful DFS benefit (HR: 0.66; 95% CI: 0.47–0.92)3
- Positive OS trend: IMFINZI® is the only perioperative IO treatment showing a 30% reduction in the risk of lung cancer-related death3
Safety
- Perioperative IMFINZI® + neoadjuvant CT is associated with a manageable AE profile, with no new safety signals observed2,3
- No impact of IMFINZI® on completion of neoadjuvant CT or surgery2,3
AE: adverse event; CI: confidence interval; CT: chemotherapy; DFS: disease-free survival; EFS: event-free survival; HR: hazard ratio; NSCLC: non-small cell lung cancer; IO: immunooncology; OS: overall survival; PD-L1: programmed death ligand 1.
Study design
AEGEAN: Study Design2
Endpoints: All efficacy analyses were performed on a modified population that excludes patients with documented EGFR/ALK aberrations§
Primary endpoints:
- pCR by central lab (per IASLC 2020)
- EFS using BICR (per RECIST v1.1)
Key secondary endpoints:
- MPR by central lab (per IASLC 2020)
- DFS using BICR (per RECIST v1.1)
- OS
* Choice of CT regimen determined by histology and at the investigator’s discretion. For non-squamous: cisplatin + pemetrexed or carboplatin + pemetrexed. For squamous: carboplatin + paclitaxel or cisplatin + gemcitabine (or carboplatin + gemcitabine for patients who have comorbidities or who are unable to tolerate cisplatin per the investigator’s judgment).
§ The protocol was amended while enrollment was ongoing to exclude (1) patients with tumours classified as T4 for any reason other than size; (2) patients with planned pneumonectomies; and (3) patients with documented EGFR/ALK aberrations.
** PORT was permitted where indicated per local guidance.
ALK: anaplastic lymphoma kinase; BICR: blinded independent central review; CT: chemotherapy; DFS: disease-free survival; EFS: event-free survival; EGFR: epidermal growth factor receptor; IASLC: International Association for the Study of Lung Cancer; MPR: major pathologic response; NSCLC: non-small cell lung cancer; OS: overall survival; pCR: pathologic complete response; PD-L1: programmed cell death ligand-1; PORT: post-operative radiotherapy; Q3W: every 3 weeks; Q4W: every 4 weeks; RECIST v1.1: Response Evaluation Criteria in Solid Tumors version 1.1.
Results
- EFS
- pCR
- DFS
- OS
- LC-specific survival
EFS* demonstrates a consistent increased trajectory over time with perioperative IMFINZI®3
39.1% maturity and 25.9 months median follow-up in censored patients.
IMFINZI® demonstrates sustained improvement in EFS vs placebo over time with estimated EFS rates of 65.0% (vs 54.4%) at 24 months and 60.1% (vs 47.9%) at 36 months3
* EFS was defined as the time from randomization to the earliest of the following: progressive disease that precluded surgery, progressive disease that was discovered and reported by the investigator when attempting surgery and that prevented completion of the surgery, local or distant recurrence using BICR per RECIST v1.1, or death from any cause.
BICR: Blinded independent central review; CI: confidence interval; EFS: event-free survival; HR: hazard ratio; NR: not reached; RECIST v1.1: Response Evaluation Criteria in Solid Tumors version 1.1.
Safety
- AE summary
- AEs by study period
Updated AE summary (safety analysis set*)3, 4
Perioperative IMFINZI® + neoadjuvant CT is associated with a manageable AE profile, with no new safety signals observed3
* The safety analysis set includes all randomized patients who received ≥1 dose of study Tx; AEs were graded using Common Terminology Criteria for Adverse Events v5.0.
† First dose of study treatment until the date of surgery or, for patients without surgery, up to the earliest of: last dose of neoadjuvant treatment + 90 days, first dose of subsequent anti-cancer treatment, or the DCO date.
‡ Date of surgery (inclusive) to the earliest of 90 days post-surgery, first dose of subsequent anticancer treatment, or DCO date.
‡‡ First dose of study treatment post-surgery until earliest of: last study treatment postsurgery + 90 days, date of first dose of subsequent anti-cancer treatment, or the DCO date.
†† First dose of study treatment until the earliest of: the last dose of study treatment or surgery (taking the latest dose of D / PBO / CT / date of surgery) + 90 days, date of the first dose of subsequent anti-cancer treatment, or the DCO date.
€ In the IMFINZI® arm: 2 fatal AEs were also reported in the adjuvant period (aortic aneurysm rupture and ILD); 3 fatal AEs were assessed as possibly related to study treatment (pneumonitis, ILD, and imLD), 2 of which were also assessed as possibly related to surgery (pneumonitis and ILD), 4 fatal AEs were assessed as unrelated to either treatment or surgery (COVID-19 pneumonia, COVID-19, pneumonia, and pneumonia streptococcal), and 4 fatal AEs were assessed as possibly related to surgery (septic shock, pneumonia, bronchopleural fistula/ pneumonia/septic shock, and post-procedural pulmonary embolism). In the Placebo arm: 4 fatal AEs were assessed as possibly related to surgery (pulmonary haemorrhage, infectious pleural effusion, acute respiratory failure, and pneumonia) and 5 fatal AEs were assessed as unrelated to surgery or treatment (multiple organ dysfunction syndrome, duodenal ulcer perforation, pneumonia/decreased appetite, COVID-19 pneumonia, and pneumonia).
§ During the overall period, included interstitial lung disease (n=2) and immune-mediated lung disease, pneumonitis, hemoptysis, myocarditis, and decreased appetite (n=1 each) in the D arm and pneumonia and infection (n=1 each) in the PBO arm. During the adjuvant period, included interstitial lung disease in the D arm and infection in the PBO arm.
¶ An AE of special interest consistent with an immune-mediated mechanism of action, where there is no clear alternate etiology, and requiring the use of systemic corticosteroids or other immunosuppressants and/or, for specific endocrine events, endocrine therapy.
** Pneumonitis is summarized as a grouped term comprising the ‘pneumonitis’, ‘interstitial lung disease’, and ‘immune-mediated lung disease’ preferred terms.
AE: adverse event; COVID-19: coronavirus disease 2019; CT: chemotherapy; D: durvalumab; DCO: data cut-off; ILD: interstitial lung disease; imLD: immune-mediated lung disease; NA: not assessed; PBO: placebo; SAE: serious AE; Tx: treatment.
Treatment and dosing
Perioperative dosing of IMFINZI®1
# Administer IMFINZI® on the same day before chemotherapy. Please also refer to the Information for Healthcare Professionals for chemotherapy agents for information on the dosage.1
* The dosage must be adjusted to body weight in patients weighing 30 kg or less, equivalent to 20 mg/kg IMFINZI® in combination with chemotherapy every 3 weeks (21 days) for 4 cycles, followed by 20 mg/kg every 4 weeks as a monotherapy until body weight increases to above 30 kg.1
CT: chemotherapy; Q3W: every 3 weeks; Q4W: every 4 weeks.
Guidelines
Swiss consensus: treatment algorithm for locally advanced, resectable and nonresectable NSCLC5
Adapted according to Werner RS, et al. 2024.5
# EGFR L858R, Ex19del, ALK, ROS1, NTRK1, 2, 3
* Approved (Swissmedic)
** Reimbursed
adj: adjuvant; AGA: actionable genomic alteration; ALK: anaplastic lymphoma kinase; Atezo: atezolizumab; cCRT: concurrent chemoradiotherapy; Cis: cisplatin; Dbl: doublet (with vinorelbin, pemetrexed, gemcitabine, docetaxel, paclitaxel); EGFR: epidermal growth factor receptor; mo: months; neoadj: neoadjuvant; Nivo: nivolumab; NSCLC: non-small cell lung cancer; NTRK: Neurotrophic tropomyosin receptor kinase; PD-L1: programmed cell death ligand 1; Pembro: pembrolizumab; Plat: platinum (cisplatin or carboplatin); RET: Rearranged during transfection; ROS: ROS proto-oncogene 1; sCRT: sequential chemoradiotherapy; st: stage; yrs: years.
References
- IMFINZI® Information for Healthcare Professionals. www.swissmedicinfo.ch.
- Heymach JV, et al. Perioperative Durvalumab for Resectable Non-Small-Cell Lung Cancer. N Engl J Med. 2023 Nov 2;389(18):1672-1684. (Including supplementary appendix).
- Heymach JV, Harpole D, Mitsudomi T, et al. Perioperative Durvalumab for Resectable NSCLC: Updated Outcomes from the Phase 3 AEGEAN Trial [presentation]. Presented at: World Conference on Lung Cancer (WCLC); Sep 7–10, 2024; San Diego, CA.
- Urban L, et al. (2024, March). 123P Updated safety of perioperative durvalumab for resectable NSCLC in AEGEAN. ESMO Open, 9, 102702.
- Werner RS, et al. Lung Cancer in Switzerland. J Thorac Oncol. 2024 Mar;19(3):385-394.
Professionals can request the mentioned references from AstraZeneca AG.