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IMFINZI® (durvalumab) approved in the US for the treatment of resectable non-small cell lung cancer before and after surgery

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AstraZeneca’s IMFINZI® (durvalumab) has been approved by the FDA for treating resectable early-stage (IIA-IIIB) non-small cell lung cancer (NSCLC) in adults without EGFR mutations or ALK rearrangements. This approval is based on the AEGEAN Phase III trial, which showed a 32% reduction in the risk of recurrence, progression, or death compared to neoadjuvant chemotherapy alone.

The trial results indicated an EFS hazard ratio of 0.68 (95% CI 0.53-0.88, P=0.003902) and a pCR rate of 17.2% for the IMFINZI regimen versus 4.3% for chemotherapy alone. The regimen includes IMFINZI with neoadjuvant chemotherapy before surgery and as adjuvant monotherapy post-surgery.

IMFINZI is also approved in the UK, Switzerland, and Taiwan based on AEGEAN results, with reviews ongoing in other regions. Notably, the regimen did not compromise surgical outcomes and was well tolerated with no new safety signals.

Il IMFINZI® (durvalumab) di AstraZeneca è stato approvato dalla FDA per il trattamento del cancro polmonare non a piccole cellule (NSCLC) resecabile in fase precoce (IIA-IIIB) negli adulti senza mutazioni EGFR o riarrangiamenti ALK. Questa approvazione si basa sul trial di Fase III AEGEAN, che ha mostrato una riduzione del 32% nel rischio di recidiva, progressione o morte rispetto alla chemioterapia neoadiuvante da sola.

I risultati della sperimentazione hanno indicato un hazard ratio EFS di 0.68 (IC 95% 0.53-0.88, P=0.003902) e un tasso di pCR del 17.2% per il regime IMFINZI rispetto al 4.3% per la sola chemioterapia. Il regime include IMFINZI con chemioterapia neoadiuvante prima dell'intervento chirurgico e come monoterapia adiuvante post-chirurgica.

IMFINZI è stato anche approvato nel Regno Unito, in Svizzera e a Taiwan sulla base dei risultati AEGEAN, con revisioni in corso in altre regioni. È fondamentale notare che il regime non ha compromesso i risultati chirurgici ed è stato ben tollerato senza nuovi segnali di sicurezza.

El IMFINZI® (durvalumab) de AstraZeneca ha sido aprobado por la FDA para el tratamiento del cáncer de pulmón no microcítico (NSCLC) resecable en etapa temprana (IIA-IIIB) en adultos sin mutaciones de EGFR ni reordenamientos de ALK. Esta aprobación se basa en el ensayo de Fase III AEGEAN, que mostró una reducción del 32% en el riesgo de recurrencia, progresión o muerte en comparación con la quimioterapia neoadyuvante sola.

Los resultados del ensayo indicaron un cociente de riesgo EFS de 0.68 (IC 95% 0.53-0.88, P=0.003902) y una tasa de pCR del 17.2% para el régimen IMFINZI frente al 4.3% para la quimioterapia sola. El régimen incluye IMFINZI con quimioterapia neoadyuvante antes de la cirugía y como monoterapia adyuvante posterior a la cirugía.

IMFINZI también cuenta con la aprobación en el Reino Unido, Suiza y Taiwán basado en los resultados de AEGEAN, con revisiones en curso en otras regiones. Cabe destacar que el régimen no comprometió los resultados quirúrgicos y fue bien tolerado sin nuevos señales de seguridad.

AstraZeneca의 IMFINZI® (두르발루맙)FDA에 의해 EGFR 돌연변이나 ALK 재배열이 없는 성인의 절제 가능한 초기 단계(IIA-IIIB) 비소세포 폐암(NSCLC) 치료를 위해 승인을 받았습니다. 이 승인은 AEGEAN 3상 시험에 근거하며, 수술 전 단독 신보조 화학요법에 비해 재발, 진행 또는 사망 위험이 32% 감소한 것으로 나타났습니다.

시험 결과는 IMFINZI 요법의 EFS 위험비가 0.68 (95% CI 0.53-0.88, P=0.003902)였고, 화학요법 단독에 비해 pCR 비율이 17.2%로 나타났습니다. 이 요법은 수술 전 신보조 화학요법과 수술 후 보조 단독요법으로 IMFINZI를 포함합니다.

IMFINZI는 AEGEAN 결과를 바탕으로 영국, 스위스 및 대만에서도 승인되었으며, 다른 지역에서도 검토가 진행 중입니다. 특히, 이 요법은 수술 결과에 부정적인 영향을 미치지 않았고, 새로운 안전 신호도 없이 잘 견뎌졌습니다.

Le IMFINZI® (durvalumab) d'AstraZeneca a été approuvé par la FDA pour traiter le cancer du poumon non à petites cellules (NSCLC) résécable à un stade précoce (IIA-IIIB) chez les adultes sans mutations EGFR ni réarrangements ALK. Cette approbation est fondée sur l', qui a montré une réduction de 32% du risque de récidive, de progression ou de décès par rapport à la chimiothérapie néoadjuvante seule.

Les résultats de l'essai ont indiqué un rapport de risque EFS de 0.68 (IC 95% 0.53-0.88, P=0.003902) et un taux de pCR de 17.2% pour le régime IMFINZI contre 4.3% pour la chimiothérapie seule. Le régime comprend IMFINZI avec chimiothérapie néoadjuvante avant la chirurgie et comme monothérapie adjuvante après la chirurgie.

IMFINZI est également approuvé au Royaume-Uni, en Suisse et à Taïwan sur la base des résultats d'AEGEAN, avec des examens en cours dans d'autres régions. Notamment, le régime n'a pas compromis les résultats chirurgicaux et a bien été toléré sans nouveaux signaux de sécurité.

Das IMFINZI® (Durvalumab) von AstraZeneca wurde von der FDA zur Behandlung von resezierbarem, frühzeitigem (IIA-IIIB) nicht-kleinzelligem Lungenkrebs (NSCLC) bei Erwachsenen ohne EGFR-Mutationen oder ALK-Umbauten genehmigt. Diese Genehmigung basiert auf der AEGEAN Phase-III-Studie, die eine 32%ige Reduktion des Risikos für Rezidive, Progression oder Tod im Vergleich zur alleinigen neoadjuvanten Chemotherapie zeigte.

Die Studienergebnisse zeigten ein EFS-Hazard-Ratio von 0.68 (95% CI 0.53-0.88, P=0.003902) und eine pCR-Rate von 17.2% für das IMFINZI-Regime im Vergleich zu 4.3% für die alleinige Chemotherapie. Das Regime umfasst IMFINZI mit neoadjuvanter Chemotherapie vor der Operation und als adjuvante Monotherapie nach der Operation.

IMFINZI ist auch im Vereinigten Königreich, in der Schweiz und in Taiwan auf der Grundlage der AEGEAN-Ergebnisse zugelassen, wobei die Überprüfungen in anderen Regionen noch laufen. Erstaunlicherweise beeinträchtigte das Regime nicht die chirurgischen Ergebnisse und wurde gut vertragen, ohne dass neue Sicherheitszeichen auftraten.

Positive
  • FDA approval of IMFINZI for resectable early-stage NSCLC.
  • 32% reduction in risk of recurrence, progression, or death with IMFINZI-based regimen.
  • EFS hazard ratio of 0.68; 95% CI 0.53-0.88; P=0.003902.
  • pCR rate of 17.2% for IMFINZI regimen vs. 4.3% for chemotherapy alone.
  • No new safety signals observed with IMFINZI.
Negative
  • Serious adverse reactions occurred in 21% of patients in the neoadjuvant phase.
  • Fatal adverse reactions included COVID-19 pneumonia, sepsis, myocarditis, decreased appetite, hemoptysis, and unspecified causes.

This FDA approval of IMFINZI for resectable early-stage NSCLC represents a significant advancement in lung cancer treatment. The 32% reduction in recurrence risk and 17.2% pathologic complete response rate are impressive results in this setting. This perioperative approach, combining immunotherapy with chemotherapy before and after surgery, has the potential to improve cure rates in early-stage disease where recurrence has been a major challenge.

The approval addresses a critical unmet need, as historically only 36-46% of Stage II and 9-24% of Stage III NSCLC patients survive 5 years post-surgery. By targeting microscopic disease early, this regimen may prevent metastases and improve long-term outcomes. However, careful patient selection and management of immune-related adverse events will be important in clinical practice.

This approval significantly expands IMFINZI's market potential into the early-stage, curative-intent setting. With an estimated 235,000 new NSCLC diagnoses expected in the US in 2024 and 25-30% being early-stage resectable cases, this represents a substantial new patient population for AstraZeneca.

The approval solidifies IMFINZI's position in lung cancer treatment, building on its success in unresectable Stage III NSCLC. This could drive significant revenue growth for AstraZeneca's oncology portfolio. However, the impact on near-term financials may be gradual as adoption in clinical practice takes time. Long-term, this approval strengthens AstraZeneca's competitive position against rivals like Merck's Keytruda and Bristol Myers Squibb's Opdivo in the lucrative immunotherapy market.

The AEGEAN trial results supporting this approval are scientifically robust. The dual primary endpoints of pathologic complete response and event-free survival provide comprehensive efficacy data. The 17.2% pCR rate with IMFINZI plus chemotherapy vs 4.3% with chemotherapy alone is particularly noteworthy.

However, it's important to note that patients with EGFR mutations or ALK rearrangements were excluded from the primary analysis. This highlights the need for continued research into optimal treatments for these molecular subgroups. The safety profile appears manageable, but long-term follow-up data will be important to fully understand the risk-benefit ratio in this curative-intent setting. Future research should focus on biomarker-driven patient selection to further optimize outcomes with this perioperative approach.

Based on AEGEAN Phase III trial results which showed IMFINZI-based regimen reduced the risk of recurrence, progression or death by 32% vs. neoadjuvant chemotherapy alone

WILMINGTON, Del.--(BUSINESS WIRE)-- AstraZeneca’s IMFINZI® (durvalumab) in combination with chemotherapy has been approved in the US for the treatment of adult patients with resectable early-stage (IIA-IIIB) non-small cell lung cancer (NSCLC) and no known epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements. In this regimen, patients are treated with IMFINZI in combination with neoadjuvant chemotherapy before surgery and as adjuvant monotherapy after surgery.

The approval by the Food and Drug Administration (FDA) was based on positive results from the pivotal AEGEAN trial, which were published in The New England Journal of Medicine in October 2023. Results from a planned interim analysis of event-free survival (EFS) showed a statistically significant and clinically meaningful 32% reduction in the risk of recurrence, progression events or death versus chemotherapy alone in patients treated with the IMFINZI-based regimen before and after surgery (32% data maturity; EFS hazard ratio of 0.68; 95% confidence interval [CI] 0.53-0.88; P=0.003902).

In a final analysis of pathologic complete response (pCR), treatment with IMFINZI plus neoadjuvant chemotherapy before surgery resulted in a pCR rate of 17.2% versus 4.3% for patients treated with neoadjuvant chemotherapy alone (difference in pCR 13.0%; 95% CI 8.7-17.6).

Each year, there are an estimated 2.4 million people diagnosed with lung cancer globally, with approximately 235,000 new diagnoses expected in the US in 2024.1-2 Around 25-30% of all patients with NSCLC, the most common form of lung cancer, are diagnosed early enough to have surgery with curative intent.3-4 However, the majority of patients with resectable disease will develop recurrence and only 36-46% of patients with Stage II disease will survive for five years.5-6 This decreases to 24% for patients with Stage IIIA disease and 9% for patients with Stage IIIB disease, reflecting a high unmet medical need.6

John V. Heymach, MD, PhD, Professor and Chair Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center in Houston, Texas, said: “This approval brings an important new treatment option that should become a backbone combination approach for patients with resectable non-small cell lung cancer, who have historically faced high rates of recurrence even after chemotherapy and surgery. When added both before and after surgery, durvalumab delivered a significant and meaningful improvement in outcomes in this curative-intent setting.”

Dave Fredrickson, Executive Vice President, Oncology Business Unit, AstraZeneca, said: “Today’s approval of IMFINZI in resectable early-stage lung cancer builds on its strong foundation of changing clinical practice in unresectable Stage III disease. We remain committed to bringing novel approaches like AEGEAN to early lung cancer settings where cure is the goal of treatment.”

IMFINZI was generally well tolerated, and no new safety signals were observed in the neoadjuvant and adjuvant settings. Further, adding IMFINZI to neoadjuvant chemotherapy was consistent with the known profile for this combination and did not compromise patients' ability to complete surgery versus chemotherapy alone.

IMFINZI is also approved in the UK, Switzerland and Taiwan (China) in this setting based on the AEGEAN results. Regulatory applications are also currently under review in the EU, China and several other countries in this indication.

IMFINZI is the only approved immunotherapy and the global standard of care in the curative-intent setting of unresectable, Stage III NSCLC in patients whose disease has not progressed after chemoradiotherapy based on the PACIFIC Phase III trial.

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 USPI 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 2.4% (34/1414), including fatal (<0.1%), and Grade 3-4 (0.4%) adverse reactions. In patients who received recent prior radiation, the incidence of pneumonitis (including radiation pneumonitis) in patients with unresectable Stage III NSCLC following definitive chemoradiation within 42 days prior to initiation of IMFINZI in PACIFIC was 18.3% (87/475) in patients receiving IMFINZI and 12.8% (30/234) in patients receiving placebo. Of the patients who received IMFINZI (475), 1.1% were fatal and 2.7% were Grade 3 adverse reactions. The frequency and severity of immune-mediated pneumonitis in patients who did not receive definitive chemoradiation prior to IMFINZI were similar in patients who received IMFINZI as a single agent or with ES-SCLC or BTC when given in combination with chemotherapy.

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 2% (37/1889) of patients receiving IMFINZI, including Grade 4 (<0.1%) and Grade 3 (0.4%) adverse reactions.

Immune-Mediated Hepatitis
IMFINZI can cause immune-mediated hepatitis. Immune-mediated hepatitis occurred in 2.8% (52/1889) of patients receiving IMFINZI, including fatal (0.2%), Grade 4 (0.3%) and Grade 3 (1.4%) adverse reactions.

Immune-Mediated Endocrinopathies

  • 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 0.5% (10/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions.

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), has 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 1.8% (34/1889) of patients receiving IMFINZI, including Grade 3 (0.4%) adverse reactions.

Other Immune-Mediated Adverse Reactions
The following clinically significant, immune-mediated adverse reactions occurred at an incidence of less than 1% each in patients who received IMFINZI or were reported with the use of other PD-1/PD-L1 blocking antibodies.

  • 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, other transplant (including corneal graft) 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 USPI 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 2.2% (42/1889) of patients receiving IMFINZI, including Grade 3 (0.3%) adverse reactions.

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. In females of reproductive potential, verify pregnancy status prior to initiating IMFINZI and advise them to use effective contraception during treatment with IMFINZI and for 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 3 months after the last dose.

Adverse Reactions

  • In patients with resectable NSCLC in the AEGEAN study, the most common adverse reactions (occurring in ≥20% of patients) were anemia, nausea, constipation, fatigue, musculoskeletal pain, and rash.
  • In patients with resectable NSCLC in the neoadjuvant phase of the AEGEAN study receiving IMFINZI in combination with platinum-containing chemotherapy (n=401), permanent discontinuation of IMFINZI due to an adverse reaction occurred in 6.7% of patients. Serious adverse reactions occurred in 21% of patients. The most frequent (≥1%) serious adverse reactions were pneumonia (2.7%), anemia (1.5%), myelosuppression (1.5%), vomiting (1.2%), neutropenia (1%), and acute kidney injury (1%). Fatal adverse reactions occurred in 2% of patients, including death due to COVID-19 pneumonia (0.5%), sepsis (0.5%), myocarditis (0.2%), decreased appetite (0.2%), hemoptysis (0.2%), and death not otherwise specified (0.2%). Of the 401 IMFINZI treated patients who received neoadjuvant treatment and 398 placebo-treated patients who received neoadjuvant treatment, 1.7% (n=7) and 1% (n=4), respectively, did not receive surgery due to adverse reactions.
  • In patients with resectable NSCLC in the adjuvant Phase of the AEGEAN study receiving IMFINZI as a single agent (n=265), permanent discontinuation of adjuvant IMFINZI due to an adverse reaction occurred in 8% of patients. Serious adverse reactions occurred in 13% of patients. The most frequent serious adverse reactions reported in >1% of patients were pneumonia (1.9%), pneumonitis (1.1%), and COVID-19 (1.1%). Four fatal adverse reactions occurred during the adjuvant phase of the study, including COVID-19 pneumonia, pneumonia aspiration, interstitial lung disease and aortic aneurysm.

The safety and effectiveness of IMFINZI has not been established in pediatric patients.

Indication:

IMFINZI in combination with platinum-containing chemotherapy as neoadjuvant treatment, followed by IMFINZI continued as a single agent as adjuvant treatment after surgery, is indicated for the treatment of adult patients with resectable (tumors ≥4 cm or node positive) non-small cell lung cancer (NSCLC) and no known epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements.

Please see Full Prescribing Information including Medication Guide for IMFINZI.

Notes

Lung cancer
Lung cancer is the leading cause of cancer death among both men and women, accounting for about one-fifth of all cancer deaths.1,7 Lung cancer is broadly split into NSCLC and small cell lung cancer (SCLC), with 80-85% of patients diagnosed with NSCLC.8-9

Early-stage lung cancer diagnoses are often only made when the cancer is found on imaging for an unrelated condition.10-11 The majority of patients with resectable disease eventually develop recurrence despite complete tumor resection and adjuvant chemotherapy.5

AEGEAN
AEGEAN is a randomized, double-blind, multi-center, placebo-controlled global Phase III trial evaluating IMFINZI as perioperative treatment for patients with resectable Stage IIA-IIIB (Eighth Edition AJCC Cancer Staging Manual) NSCLC, irrespective of PD-L1 expression. Perioperative therapy includes treatment before and after surgery, also known as neoadjuvant/adjuvant therapy. In the trial, 802 patients were randomized to receive a 1500 mg fixed dose of IMFINZI plus chemotherapy or placebo plus chemotherapy every three weeks for four cycles prior to surgery, followed by IMFINZI or placebo every four weeks (for up to 12 cycles) after surgery. Patients with known EGFR or ALK genomic tumor aberrations were excluded from the primary efficacy analyses.

In the AEGEAN trial, the primary endpoints were pCR, defined as no viable tumor in the resection specimen (including lymph nodes) following neoadjuvant therapy, and EFS, defined as the time from randomization to an event like tumor recurrence, progression precluding definitive surgery, or death. Key secondary endpoints were major pathologic response, defined as residual viable tumor of less than or equal to 10% in the resected primary tumor following neoadjuvant therapy, disease-free survival, overall survival (OS), safety and quality of life. The final pathologic response analyses were performed after all patients had the opportunity for surgery and pathology assessment per the trial protocol. The trial enrolled participants from 264 centers in more than 25 countries including in the US, Canada, Europe, South America and Asia.

IMFINZI
IMFINZI® (durvalumab) is a human monoclonal antibody that binds to the PD-L1 protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins, countering the tumor's immune-evading tactics and releasing the inhibition of immune responses.

IMFINZI is the only approved immunotherapy and the global standard of care in the curative-intent setting of unresectable, Stage III NSCLC in patients whose disease has not progressed after chemoradiotherapy. IMFINZI in combination with chemotherapy (etoposide and either carboplatin or cisplatin) is also approved for the treatment of extensive-stage SCLC and in combination with a short course of tremelimumab-actl and chemotherapy for the treatment of metastatic NSCLC.

In limited-stage SCLC, IMFINZI demonstrated statistically significant and clinically meaningful improvements in the dual primary endpoints of OS and progression-free survival compared to placebo in patients who had not progressed following standard-of-care concurrent chemoradiotherapy in the ADRIATIC Phase III trial.

In addition to its indications in lung cancers, IMFINZI is approved in combination with chemotherapy (gemcitabine plus cisplatin) in locally advanced or metastatic biliary tract cancer and in combination with tremelimumab-actl in unresectable hepatocellular carcinoma (HCC). IMFINZI is also approved as a monotherapy in unresectable HCC in Japan and the EU and in combination with chemotherapy (carboplatin plus paclitaxel) followed by IMFINZI monotherapy in primary advanced or recurrent endometrial cancer that is mismatch repair deficient in the US.

Since the first approval in May 2017, more than 220,000 patients have been treated with IMFINZI. 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 SCLC, NSCLC, breast cancer, bladder cancer, several gastrointestinal and gynaecologic cancers, and other solid tumors.

AstraZeneca in lung cancer
AstraZeneca is working to bring patients with lung cancer closer to cure through the detection and treatment of early-stage disease, while also pushing the boundaries of science to improve outcomes in the resistant and advanced settings. By defining new therapeutic targets and investigating innovative approaches, the Company aims to match medicines to the patients who can benefit most.

The Company’s comprehensive portfolio includes leading lung cancer medicines and the next wave of innovations, including osimertinib and gefitinib; IMFINZI and tremelimumab-actl; fam-trastuzumab deruxtecan-nxki 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.

AstraZeneca is a founding member of the Lung Ambition Alliance, a global coalition working to accelerate innovation and deliver meaningful improvements for people with lung cancer, including and beyond treatment.

AstraZeneca in immuno-oncology (IO)
AstraZeneca is a pioneer in introducing the concept of immunotherapy into dedicated clinical areas of high unmet medical need. The Company has a comprehensive and diverse IO portfolio and pipeline anchored in immunotherapies designed to overcome evasion of the anti-tumor immune response and stimulate the body’s immune system to attack tumors.

AstraZeneca strives to redefine cancer care and help transform outcomes for patients with IMFINZI as a monotherapy and in combination with tremelimumab-actl as well as other novel immunotherapies and modalities. The Company is also investigating next-generation immunotherapies like bispecific antibodies and therapeutics that harness different aspects of immunity to target cancer, including cell therapy and T cell engagers.

AstraZeneca is pursuing an innovative clinical strategy to bring IO-based therapies that deliver long-term survival to new settings across a wide range of cancer types. The Company is focused on exploring novel combination approaches to help prevent treatment resistance and drive longer immune responses. With an extensive clinical program, the Company also champions the use of IO treatment in earlier disease stages, where there is the greatest potential for cure.

AstraZeneca in oncology
AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients.

The Company's focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyze changes in the practice of medicine and transform the patient experience.

AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death.

AstraZeneca
AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines in Oncology, Rare Diseases and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 125 countries, and its innovative medicines are used by millions of patients worldwide. For more information, please visit www.astrazeneca-us.com and follow us on social media @AstraZeneca.

References

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  2. American Cancer Society. Key Statistics for Lung Cancer. Available at: https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html. Accessed August 2024.
  3. Cagle PT, et al. Lung Cancer Biomarkers: Present Status and Future Developments. Arch Pathol Lab Med. 2013;137(9):1191-1198.
  4. Le Chevalier T. Adjuvant Chemotherapy for Resectable Non-Small-Cell Lung Cancer: Where is it Going? Ann Oncol. 2010;21(suppl 7):vii196-198.
  5. Pignon JP, et al. Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26(21):3552-3559.
  6. Goldstraw P, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2(8):706-14.
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  8. LUNGevity Foundation. Types of Lung Cancer. Available at: https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/types-of-lung-cancer. Accessed August 2024.
  9. 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.
  10. Sethi S, et al. Incidental Nodule Management – Should There Be a Formal Process? J Thorac Dis. 2016:8(Suppl 6);S494-S497.
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US-92271 Last Updated 8/24

Media Inquiries

Brendan McEvoy, +1 302 885 2677

Chelsea Tressler, +1 302 885 2677

US Media Mailbox: usmediateam@astrazeneca.com

Source: AstraZeneca

FAQ

What is the new FDA approval for IMFINZI (AZN) related to?

The FDA approved IMFINZI for treating resectable early-stage non-small cell lung cancer (NSCLC) in adults without EGFR mutations or ALK rearrangements.

What were the key results of the AEGEAN Phase III trial for IMFINZI (AZN)?

The AEGEAN trial showed a 32% reduction in the risk of recurrence, progression, or death with an EFS hazard ratio of 0.68 and a pCR rate of 17.2% for the IMFINZI regimen.

What is the significance of the EFS hazard ratio reported in the AEGEAN Phase III trial for IMFINZI (AZN)?

The EFS hazard ratio of 0.68 indicates a statistically significant and clinically meaningful reduction in the risk of recurrence, progression, or death compared to chemotherapy alone.

Is IMFINZI (AZN) approved in other regions based on AEGEAN trial results?

Yes, IMFINZI is also approved in the UK, Switzerland, and Taiwan, with regulatory reviews ongoing in the EU, China, and other countries.

What are the potential adverse reactions associated with IMFINZI (AZN) in the AEGEAN study?

Serious adverse reactions included pneumonia, anemia, myelosuppression, vomiting, neutropenia, and acute kidney injury, with some fatal cases reported.

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