Limited-stage (LS) small-cell lung cancer (SCLC) remains an area of high unmet medical need. The standard-of-care therapy comprises curative-intent platinum-based chemotherapy with concurrent radiotherapy (cCRT), which can be followed by prophylactic brain irradiation and then observation. However, most patients will relapse. Durvalumab (antiprogrammed cell death ligand-1) has enhanced the efficacy outcomes after cCRT for patients with unresectable, stage III non-small-cell lung cancer. Recently, durvalumab combined with platinum-etoposide demonstrated a significant survival benefit compared with platinum-etoposide as first-line treatment of patients with extensive-stage SCLC and has also shown antitumor activity as monotherapy and combined with tremelimumab (anticytotoxic T-lymphocyte–associated antigen-4) in pretreated patients with extensive-stage SCLC. ADRIATIC, a phase III, randomized, double-blind, placebo-controlled, multicenter, global study (ClinicalTrials.gov identifier, NCT03703297), is designed to investigate the efficacy of durvalumab, with or without tremelimumab, as consolidation therapy for patients with LS-SCLC without disease progression after cCRT. Approximately 600 patients with documented histologic or cytologic LS-SCLC, World Health Organization/Eastern Cooperative Oncology Group performance status 0 or 1, and no progression after 4 cycles of cCRT will be randomized (1:1:1) to treatment (durvalumab 1500 mg plus placebo every 4 weeks [q4w] for 4 cycles, followed by durvalumab 1500 mg q4w; durvalumab 1500 mg plus tremelimumab 75 mg q4w for 4 cycles, followed by durvalumab 1500 mg q4w; or dual placebo q4w for 4 cycles, followed by single placebo q4w) within 1 to 42 days of completing cCRT, stratified by stage and receipt of prophylactic brain irradiation. The primary endpoints are progression-free survival and overall survival. The secondary endpoints are overall survival and progression-free survival rates, objective response rate, and safety and tolerability. Recruitment began in September 2018.
Bibliographical noteFunding Information:
S.S. has received research grants and personal fees (advisory boards and speaker fees) from AstraZeneca and personal fees (advisory boards) from Merck and Celgene, all outside the submitted work. I.O. has received research grants from Boehringer-Ingelheim during the conduct of the study; research grants and personal fees from AstraZeneca , Taiho Pharmaceutical , Chugai Pharma, Boehringer-Ingelheim, Ono Pharmaceutical , MSD Oncology, Lilly , and Bristol-Myers Squibb ; research grants from Astellas Pharma , Novartis , and AbbVie ; and personal fees from Pfizer, all outside the submitted work. Y.C. has received research grants from AstraZeneca , ISPEN , Roche , and Bristol-Myers Squibb ; personal fees (consultancy, speakers’ bureau) from AstraZeneca, Genentech, Bristol-Myers Squibb, Novartis, and Takeda; personal fees (speakers’ bureau) from Merck, Eli Lilly, and Guardant Health; and personal fees (consultancy) from Pfizer and Array Biopharma, all outside the submitted work. S.N. has received research grants from Merck Serono; research grants and personal fees (honoraria) from AstraZeneca , Pfizer , MSD , and Eli Lilly; and personal fees (honoraria) from Chugai, Taiho, Bristol-Myers Squibb, Novartis, Boehringer-Ingelheim, Shionogi, and Yakult, all outside the submitted work. B.C.C. has received research funding from Novartis , Bayer , AstraZeneca , MOGAM Institute , Dong-A ST , Champions Oncology , Janssen , Yuhan , Ono , Dizal Pharma , and MSD ; has provided consultancy for Novartis, AstraZeneca, Boehringer-Ingelheim, Roche, BMS, Ono, Yuhan, Pfizer, Eli Lilly, Janssen, Takeda, and MSD; has stock ownership in TheraCanVac Inc, Gencurix Inc, and Bridgebio Therapeutics; and has received royalties from Champions Oncology. G.M. and N.S. are full-time employees of AstraZeneca. W.Y. and H.J. are full-time employees of AstraZeneca and have stock ownership in AstraZeneca. The remaining author declares that they have no competing interests.
Medical writing support, which was in accordance with Good Publication Practice guidelines, was provided by Craig Turner, MSc, of Cirrus Communications, an Ashfield company (Macclesfield, UK), and was funded by AstraZeneca .
All Science Journal Classification (ASJC) codes
- Pulmonary and Respiratory Medicine
- Cancer Research