According to an update from the phase III PEARL trial, durvalumab (AstraZeneca’s Imfinzi) failed to significantly improve overall survival (OS) as a frontline treatment option in patients with stage IV non–small cell lung cancer (NSCLC) with high expression (25% or more) of PD-L1 or in a subgroup of patients at low risk of early mortality as compared to platinum-based chemotherapy. However, a clinically meaningful improvement in OS was seen in patients with 50% or a higher expression of PD-L1.
Durvalumab is a monoclonal antibody against PD-L1 that blocks PD-L1 ‘s interaction with PD-1 and thus prevents tumour cells from evading the immune response. The PEARL study compared the efficacy of Durvalumab immunotherapy against standard platinum-based chemotherapy.
The multicentre, open, randomised, phase III global PEARL study enrolled NSCLC patients with high PD-L1 expression (≥25%). The participants were primarily Asian, including smokers and non-smokers with squamous and non-squamous histology, excluding those with EGFR or ALK alterations. The study’s primary endpoints were OS in patients with high PD-L1 expression and OS in subgroups with a low risk of early mortality.
Durvalumab treatment for patients with metastatic NSCLC in a frontline setting showed encouraging results only in a subgroup of patients with high expression of PD-L1 (50% or more). The treatment regimen was safe and tolerable, with no new safety signals reported.