IMFINZI Combined With Novel Immunotherapies Improved Clinical Outcomes for Patients With Unresectable, Stage III Non-Small Cell Lung Cancer
Results from the COAST Phase II trial show that combining oleclumab or monalizumab with IMFINZI significantly delays disease progression and enhances response rates in patients with unresectable Stage III NSCLC post-chemoradiation. The trial revealed a 56% reduced progression risk with oleclumab and 35% with monalizumab, alongside increased progression-free survival rates. Additionally, PACIFIC-R data suggests long-term efficacy for IMFINZI in a real-world context, with a median progression-free survival of 21.7 months. AstraZeneca plans to initiate registrational trials based on these promising findings.
- COAST Phase II trial showed oleclumab reduced progression risk by 56% and monalizumab by 35%.
- Ten-month progression-free survival rates were 64.8% with oleclumab and 72.7% with monalizumab, compared to 39.2% with IMFINZI alone.
- PACIFIC-R data indicated a median progression-free survival of 21.7 months in a real-world setting.
- None.
COAST Phase II trial showed oleclumab or monalizumab in combination with IMFINZI significantly delayed disease progression and increased objective response rate
First effectiveness data from PACIFIC-R reinforced long-term benefit of IMFINZI in the real-world setting
After a median follow-up of 11.5 months, the results of an interim analysis showed IMFINZI in combination with oleclumab reduced the risk of disease progression or death by
The results, presented during the
One in four patients with NSCLC are diagnosed at Stage III, where the majority of tumors are unresectable (cannot be removed with surgery).1,2 IMFINZI after CRT is the global standard of care for patients in this setting, based on the PACIFIC Phase III trial.3-5
Safety was similar across treatment arms with no new safety signals identified for either IMFINZI combination. Incidence of Grade 3 or higher treatment-emergent adverse events (TEAE; all cause) were
The most common Grade 3/4 TEAE was dyspnea (reported in
PACIFIC-real world observational study (PACIFIC-R) demonstrated benefit of IMFINZI in real-world setting at the
Data from a planned analysis of real-world PFS (rwPFS) from the PACIFIC-R observational study was also presented during ESMO, showing the first effectiveness data from over a thousand patients with unresectable, Stage III NSCLC who were treated with IMFINZI in the real-world setting as part of AstraZeneca’s global PACIFIC Early Access Program. The analysis showed a median rwPFS of 21.7 months in the real-world setting.
In comparison, a median PFS of 16.9 months was observed among patients treated with IMFINZI in the randomized, double-blinded, placebo-controlled PACIFIC Phase III trial. These results demonstrate the long-term effectiveness of IMFINZI in this real-world patient population and reinforce the PACIFIC regimen as the established standard of care today following platinum-based CRT.
IMFINZI is approved in the curative-intent setting of unresectable, Stage III NSCLC after CRT in the US,
IMPORTANT SAFETY INFORMATION
There are no contraindications for IMFINZI® (durvalumab).
Immune-Mediated Adverse Reactions
Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions. Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting treatment or after discontinuation. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. Withhold or permanently discontinue IMFINZI depending on severity. See Dosing and Administration for specific details. In general, if IMFINZI requires interruption or discontinuation, administer systemic corticosteroid therapy (1 mg to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy.
Immune-Mediated Pneumonitis
IMFINZI can cause immune-mediated pneumonitis. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation. In patients who did not receive recent prior radiation, the incidence of immune-mediated pneumonitis was
Immune-Mediated Colitis
IMFINZI can cause immune-mediated colitis that is frequently associated with diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies. Immune-mediated colitis occurred in
Immune-Mediated Hepatitis
IMFINZI can cause immune-mediated hepatitis. Immune-mediated hepatitis occurred in
Immune-Mediated Endocrinopathies
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Adrenal Insufficiency: IMFINZI can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. Immune-mediated adrenal insufficiency occurred in
0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1% ) adverse reactions. -
Hypophysitis: IMFINZI can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field cuts. Hypophysitis can cause hypopituitarism. Initiate symptomatic treatment including hormone replacement as clinically indicated. Grade 3 hypophysitis/hypopituitarism occurred in <
0.1% (1/1889) of patients who received IMFINZI. - Thyroid Disorders: IMFINZI can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement therapy for hypothyroidism or institute medical management of hyperthyroidism as clinically indicated.
-
Thyroiditis: Immune-mediated thyroiditis occurred in
0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1% ) adverse reactions. -
Hyperthyroidism: Immune-mediated hyperthyroidism occurred in
2.1% (39/1889) of patients receiving IMFINZI. -
Hypothyroidism: Immune-mediated hypothyroidism occurred in
8.3% (156/1889) of patients receiving IMFINZI, including Grade 3 (<0.1% ) adverse reactions. -
Type 1 Diabetes Mellitus, which can present with diabetic ketoacidosis: Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated. Grade 3 immune-mediated type 1 diabetes mellitus occurred in <
0.1% (1/1889) of patients receiving IMFINZI.
Immune-Mediated Nephritis with Renal Dysfunction
IMFINZI can cause immune-mediated nephritis. Immune-mediated nephritis occurred in
Immune-Mediated Dermatology Reactions
IMFINZI can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis (TEN), have occurred with PD-1/L-1 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes. Immune-mediated rash or dermatitis occurred in
Other Immune-Mediated Adverse Reactions
The following clinically significant, immune-mediated adverse reactions occurred at an incidence of less than
- Cardiac/vascular: Myocarditis, pericarditis, vasculitis.
- Nervous system: Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barré syndrome, nerve paresis, autoimmune neuropathy.
- Ocular: Uveitis, iritis, and other ocular inflammatory toxicities can occur. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada-like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss.
- Gastrointestinal: Pancreatitis including increases in serum amylase and lipase levels, gastritis, duodenitis.
- Musculoskeletal and connective tissue disorders: Myositis/polymyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatic.
- Endocrine: Hypoparathyroidism
- Other (hematologic/immune): Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection.
Infusion-Related Reactions
IMFINZI can cause severe or life-threatening infusion-related reactions. Monitor for signs and symptoms of infusion-related reactions. Interrupt, slow the rate of, or permanently discontinue IMFINZI based on the severity. See Dosing and Administration for specific details. For Grade 1 or 2 infusion-related reactions, consider using pre-medications with subsequent doses. Infusion-related reactions occurred in
Complications of Allogeneic HSCT after IMFINZI
Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/L-1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/L-1 blockade and allogeneic HSCT. Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/L-1 blocking antibody prior to or after an allogeneic HSCT.
Embryo-Fetal Toxicity
Based on its mechanism of action and data from animal studies, IMFINZI can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with IMFINZI and for at least 3 months after the last dose of IMFINZI.
Lactation
There is no information regarding the presence of IMFINZI in human milk; however, because of the potential for adverse reactions in breastfed infants from IMFINZI, advise women not to breastfeed during treatment and for at least 3 months after the last dose.
Adverse Reactions
-
In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), the most common adverse reactions (≥
20% ) were cough (40% ), fatigue (34% ), pneumonitis or radiation pneumonitis (34% ), upper respiratory tract infections (26% ), dyspnea (25% ), and rash (23% ). The most common Grade 3 or 4 adverse reactions (≥3% ) were pneumonitis/radiation pneumonitis (3.4% ) and pneumonia (7% ) -
In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), discontinuation due to adverse reactions occurred in
15% of patients in the IMFINZI arm. Serious adverse reactions occurred in29% of patients receiving IMFINZI. The most frequent serious adverse reactions (≥2% ) were pneumonitis or radiation pneumonitis (7% ) and pneumonia (6% ). Fatal pneumonitis or radiation pneumonitis and fatal pneumonia occurred in <2% of patients and were similar across arms -
In patients with extensive-stage SCLC in the
CASPIAN study receiving IMFINZI plus chemotherapy (n=265), the most common adverse reactions (≥20% ) were nausea (34% ), fatigue/asthenia (32% ), and alopecia (31% ). The most common Grade 3 or 4 adverse reaction (≥3% ) was fatigue/asthenia (3.4% ) -
In patients with extensive-stage SCLC in the
CASPIAN study receiving IMFINZI plus chemotherapy (n=265), IMFINZI was discontinued due to adverse reactions in7% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in31% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least1% of patients were febrile neutropenia (4.5% ), pneumonia (2.3% ), anemia (1.9% ), pancytopenia (1.5% ), pneumonitis (1.1% ), and COPD (1.1% ). Fatal adverse reactions occurred in4.9% of patients receiving IMFINZI plus chemotherapy
The safety and effectiveness of IMFINZI have not been established in pediatric patients.
Indications:
IMFINZI is indicated for the treatment of adult patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.
IMFINZI, in combination with etoposide and either carboplatin or cisplatin, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
Please see complete Prescribing Information, including Medication Guide.
About Stage III NSCLC
In 2021, an estimated 235,760 new cases of lung cancer will be diagnosed in
Stage III (locally advanced) NSCLC is commonly divided into three sub-categories (
The majority of Stage III NSCLC patients are diagnosed with unresectable tumors.1,2 Prior to the approval of IMFINZI in this setting, no new treatments beyond CRT had been available to these patients for decades.3-4,9
About COAST
COAST is a Phase II, multi-arm, randomized trial investigating IMFINZI alone or in combination with either oleclumab (anti-CD73 monoclonal antibody) or monalizumab (anti-NKG2A monoclonal antibody) in 189 patients with locally advanced, unresectable Stage III NSCLC who had not progressed after CRT.
COAST is being conducted in 82 centers across 9 countries in
About PACIFIC-R
About IMFINZI® (durvalumab)
IMFINZI is a human monoclonal antibody that binds to PD-L1 and blocks the interaction of PD-L1 with PD-1 and CD80, countering the tumor’s immune-evading tactics and releasing the inhibition of immune responses.
In addition to approvals in unresectable, Stage III NSCLC and ES-SCLC, IMFINZI is also approved for previously treated patients with advanced bladder cancer in several countries.
As part of a broad development program, IMFINZI is being tested as a single treatment and in combinations with other anti-cancer treatments for patients with NSCLC, SCLC, bladder cancer, hepatocellular carcinoma, biliary tract cancer (a form of liver cancer), esophageal cancer, gastric and gastroesophageal cancer, cervical cancer, ovarian cancer, endometrial cancer, and other solid tumors.
About Oleclumab
Oleclumab is a potentially first-in-class, anti-CD73 monoclonal antibody that selectively binds to and inhibits the activity of CD73. CD73 is a cell surface enzyme which is overexpressed in the tumor microenvironment and promotes tumor growth by limiting anti-tumor immunity via the adenosine receptor pathway.
Preclinical studies have demonstrated that CD73 blockade improved anti-tumor activity in combination with radiotherapy, chemotherapy and immunotherapy. Oleclumab is also being examined in various Phase II trials for solid tumor malignancies.
About Monalizumab
Monalizumab is a potentially first-in-class, anti-NKG2A antibody. NKG2A is a checkpoint receptor expressed on tumor-infiltrating cytotoxic T-cells and natural killer cells that inhibits their anti-cancer functions.
Monalizumab is also being studied in the ongoing INTERLINK-1 Phase III trial, evaluating monalizumab in combination with cetuximab for the treatment of patients with previously-treated recurrent or metastatic head and neck squamous cell carcinoma.
Monalizumab is being developed in collaboration with Innate Pharma.
About AstraZeneca Support Programs
Additionally,
About
The Company’s comprehensive portfolio includes leading lung cancer medicines and the next wave of innovations including osimertinib; durvalumab and tremelimumab; trastuzumab deruxtecan and datopotamab deruxtecan in collaboration with Daiichi Sankyo; savolitinib in collaboration with HUTCHMED; as well as a pipeline of potential new medicines and combinations across diverse mechanisms of action.
About
Immunotherapy is a therapeutic approach designed to stimulate the body’s immune system to attack tumors. The Company’s Immuno-Oncology (IO) portfolio is anchored in immunotherapies that have been designed to overcome anti-tumor immune suppression.
The Company is pursuing a comprehensive clinical-trial program that includes IMFINZI as a single treatment and in combination with tremelimumab and other novel antibodies in multiple tumor types, stages of disease, and lines of treatment, and where relevant using the PD-L1 biomarker as a decision-making tool to define the best potential treatment path for a patient. In addition, the ability to combine the IO portfolio with radiation, chemotherapy, small, targeted molecules from across AstraZeneca’s oncology pipeline, and from research partners, may provide new treatment options across a broad range of tumors.
About
The Company’s focus is on some of the most challenging cancers. It is through persistent innovation that
About
References
- EpiCast Report: NSCLC Epidemiology Forecast to 2025. GlobalData. 2016.
-
Provencio M, et al. Inoperable Stage III Non-Small Cell
Lung Cancer : Current Treatment and Role Of Vinorelbine. J Thorac Dis. 2011;3:197-204. -
Cheema PK, et al. Perspectives on Treatment Advances for Stage III Locally Advanced Unresectable Non-Small-Cell
Lung Cancer . Curr Oncol. 2019;26(1):37–42. -
Curran WJ, et al. Sequential vs Concurrent Chemoradiation for Stage III Non–Small Cell
Lung Cancer : Randomized Phase III Trial RTOG 9410. J Natl Cancer Inst. 2011;103(19):1452-1460. -
American Cancer Society . Key Statistics forLung Cancer . Available at https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html.AccessedSeptember 2021 . -
American Cancer Society . What isLung Cancer . Available at https://www.cancer.org/cancer/lung-cancer/about/what-is.html. AccessedSeptember 2021 . -
Anthonia SJ et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell
Lung Cancer . N Engl J Med. 2017;377:1919-1929. -
ASCO. Cancer.net.
Lung Cancer – Non-Small Cell. Available at https://www.cancer.net/cancer-types/lung-cancer/view-all. AccessedSeptember 2021 . -
Hanna N, et al. Current Standards and Clinical Trials in Systemic Therapy for Stage III
Lung Cancer : What is New? Am Soc Clin Oncol Educ Book. 2015:e442-447.
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