Imfinzi

The active substance in Imfinzi, durvalumab, is a monoclonal antibody, a type of protein designed to attach to a protein called PD-L1, which is present on the surface of many cancer cells.

PD-L1 acts to switch off immune cells that would otherwise attack the cancer cells. By attaching to PD-L1 and blocking its effects, Imfinzi increases the ability of the immune system to attack the cancer cells and thereby slows down the progression of the disease.

Imfinzi received a marketing authorisation valid throughout the EU on 21 September 2018.

For the full list of side effects and restrictions with Imfinzi, see the package leaflet.

When Imfinzi is given alone, the most common side effects (which may affect more than 1 in 10 people) include cough, diarrhoea, rash, joint pain, fever, abdominal (belly) pain, nose and throat infections, itching and hypothyroidism (an underactive thyroid gland).

When Imfinzi is given together with chemotherapy, the most common side effects (which may affect more than 1 in 10 people) include neutropenia (low levels of neutrophils, which fight infections), anaemia (low levels of red blood cells), tiredness, nausea (feeling sick), thrombocytopenia (low levels of platelets in the blood), hair loss, constipation, decreased appetite, peripheral neuropathy (nerve damage in arms and legs), abdominal pain, diarrhoea, rash, vomiting, leucopenia (low levels of white blood cells),fever, joint pain, cough, itching, hypothyroidism, increased level of liver enzymes and peripheral oedema (swelling, especially of the ankles and feet).

When Imfinzi is given with tremelimumab and chemotherapy for non-small cell lung cancer, the most common side effects (which may affect more than 1 in 5 people) include anaemia, nausea, neutropenia (low levels of neutrophils, a type of white blood cell that fights infection), tiredness, rash, thrombocytopenia and diarrhoea.

When Imfinzi is given with tremelimumab for hepatocellular cancer, the most common side effects (which may affect more than 1 in 10 people) include rash, itching, diarrhoea, abdominal pain, increased levels of liver enzymes, fever, hypothyroidism, cough, and peripheral oedema (swelling especially of the ankles and feet); increased levels of lipase may affect up to 1 in 10 people.

When Imfinzi is given together with chemotherapy and followed by Imfinzi with olaparib, the most common side effects (which may affect more than 1 in 5 people) include anaemia, nausea, tiredness, peripheral neuropathy, hair loss, neutropenia, constipation, thrombocytopenia, diarrhoea, vomiting, joint pain, rash, abdominal pain, decreased appetite and leucopenia.

Imfinzi can only be obtained with a prescription and treatment should be started and supervised by a doctor experienced in treating cancer. It is given by infusion (drip) into a vein.

The dose of Imfinzi and how often it is given depends on the type of cancer being treated. Treatment can continue for as long as the patient benefits from it or for up to 1 year for locally advanced NSCLC and 2 years for limited-stage SCLC.

Treatment may be paused or stopped permanently if the patient gets severe side effects.

For more information about using Imfinzi, see the package leaflet or contact your doctor or pharmacist.

Non-small cell lung cancer

In one main study of 713 patients with locally advanced NSCLC, patients given Imfinzi lived on average for around 17 months without their disease getting worse, compared with 6 months for those given placebo (a dummy treatment). Preliminary results also indicated that patients given Imfinzi lived longer overall compared with patients on placebo.

In another main study of patients with metastatic NSCLC, 338 patients given Imfinzi in combination with tremelimumab and chemotherapy lived on average for 14 months, compared with 12 months for 337 patients given only chemotherapy. They also lived longer without their disease getting worse: around 6 months on average, compared with 5 months for patients who only received chemotherapy.

Small cell lung cancer

In a main study of 805 patients with extensive-stage SCLC, patients given Imfinzi together with chemotherapy lived on average for 13 months compared with 10 months for those given chemotherapy alone.

In another main study, Imfinzi was compared with placebo in 730 patients with limited-stage SCLC whose disease had not progressed following platinum-based chemoradiation therapy. Patients given Imfinzi lived for 55.9 months on average, compared with 33.4 months on average for those given placebo. They also lived longer without their disease getting worse: around 16.6 months on average, compared with 9.2 months on average for patients given placebo.

Biliary tract cancer

In a study with 685 patients with advanced biliary tract cancer, patients who received Imfinzi plus gemcitabine and cisplatin lived on average for 12.8 months, compared with 11.5 for those who received placebo plus gemcitabine and cisplatin.

Hepatocellular carcinoma

In a main study involving patients with advanced hepatocellular cancer who had not been treated before, Imfinzi given on its own and in combination with tremelimumab increased the time patients lived overall compared with standard treatment (sorafenib). Patients who received either Imfinzi on its own (389 patients) or together with tremelimumab (393 patients) lived for an average of 16.6 months and 16.4 months, respectively, compared with an average of 13.8 months for those who received sorafenib (389 patients).

In about 17% of patients who received Imfinzi on its own, the tumour shrank or disappeared; this response lasted for about 17 months on average. While in about 20% of patients who received Imfinzi with tremelimumab, the tumour shrank or disappeared, with the response lasting about 22 months on average. About 5% of patients who received sorafenib had a response to treatment and their response lasted on average 18 months.

Endometrial cancer

A main study consisting of two parts involved 718 patients with advanced or recurrent endometrial cancer who had not been treated before.

In the first part of the study, lasting 6 treatment cycles (18 weeks), two groups of patients were given standard treatment (carboplatin and paclitaxel) plus Imfinzi, and a third group was given standard treatment and placebo. In the second part of the study, patients whose disease had not worsened since starting treatment were included for maintenance treatment. The two groups of patients who received standard treatment plus Imfinzi in the first part of the study were given either Imfinzi in combination with olaparib or Imfinzi with a placebo; the group of patients given standard treatment and placebo continued on placebo only.

Patients given standard treatment plus Imfinzi in the first part and Imfinzi and placebo during maintenance treatment lived, on average, for 10.2 months before their disease got worse. In patients starting on standard treatment plus Imfinzi and continuing on Imfinzi and olaparib maintenance therapy this was 15.1 months. Patients given standard treatment with placebo in the first part of the study and placebo during maintenance lived, on average, for 9.6 months before they their disease got worse. Supportive analyses showed a benefit of maintenance therapy with Imfinzi and placebo or Imfinzi with olaparib in patients whose cancer was MMR deficient (dMMR). In patients whose cancer was MMR proficient (pMMR), a benefit was seen with Imfinzi plus olaparib but not with Imfinzi and placebo.

Imfinzi was shown to increase the time patients with locally advanced NSCLC and endometrial cancer lived without their disease getting worse and the time patients with small cell lung cancer, advanced hepatocellular carcinoma or advanced biliary tract cancer lived overall. However, in patients with endometrial cancer there are uncertainties around the long-term benefits of treatment and these will be addressed in ongoing studies. In combination with tremelimumab, Imfinzi had beneficial effects in patients with NSCLC and in those with hepatocellular carcinoma. The use of Imfinzi in patients with locally advanced NSCLC is restricted to those whose cancer produces PD-L1, since a clear benefit was only shown in this group of patients. Side effects with Imfinzi were considered manageable, and its safety profile acceptable and in line with that of similar medicines.

The European Medicines Agency therefore decided that Imfinzi’s benefits are greater than its risks and it can be authorised for use in the EU.

The company that markets Imfinzi will provide the interim results and final results of the main study in patients with endometrial cancer to confirm the long-term benefit of the medicine in combination with olaparib in patients whose cancer is MMR proficient, and maintenance therapy with Imfinzi on its own in patients whose cancer is MMR deficient.

Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Imfinzi have also been included in the summary of product characteristics and the package leaflet.

As for all medicines, data on the use of Imfinzi are continuously monitored. Side effects reported with Imfinzi are carefully evaluated and any necessary action taken to protect patients.