The National Institute for Health and Care Excellence (NICE) has approved durvalumab (Imfinzi) for NHS use in England and Wales, marking the first treatment advancement for limited-stage small cell lung cancer (LS-SCLC) in over 30 years. The AstraZeneca immunotherapy is recommended for adults whose disease has not progressed following initial treatment with platinum-based chemotherapy and/or radiotherapy.
Significant Survival Benefits Demonstrated
The NICE recommendation follows results from the phase 3 ADRIATIC trial, which demonstrated substantial clinical benefits for patients treated with durvalumab. The trial found that median overall survival for people taking durvalumab was 55.9 months compared with 33.4 months for those receiving placebo, representing a 22.5-month improvement. At three years, 56.5% of patients treated with durvalumab were still alive versus 48% for placebo.
The study also showed durvalumab reduced the risk of death by 27% (HR 0.73; 95% CI 0.57–0.93; p=0.0104), regardless of chemotherapy regimen or use of prophylactic cranial irradiation. Additionally, median progression-free survival was 16.6 months for those on durvalumab compared to 9.2 months for those on placebo.
Addressing Critical Unmet Medical Need
Small cell lung cancer is an aggressive disease that grows rapidly and spreads quickly to other areas of the body. Limited-stage SCLC affects approximately 30% of SCLC patients, where the cancer is contained in a single area on one side of the chest. Just over 1,000 people in England are diagnosed with limited-stage SCLC each year, with an estimated 530 people expected to benefit from the new treatment.
Prior to this approval, there were no standard maintenance treatments available for people with limited-stage SCLC that had not progressed after chemoradiotherapy, with only active monitoring offered. Surgery may be an option for some people with early-stage SCLC but is not possible for most patients as the disease is usually diagnosed at a later stage.
Treatment Administration and Mechanism
Durvalumab is administered by infusion every 2-4 weeks depending on the patient's body weight. The immunotherapy works by helping the immune system fight cancer cells. The drug is available on the NHS from today following NICE's final draft guidance.
Clinical Impact and Expert Perspectives
Helen Knight, director of Medicines Evaluation at NICE, emphasized the significance of the approval: "I am very pleased we have been able to recommend this effective new treatment for a highly aggressive form of lung cancer with limited treatment options. This is a devastating disease with a poor prognosis, so a drug proven to improve the length and quality of people's lives, giving them more precious time with their family and friends, is most welcome."
Dr Kevin Franks, Thoracic Consultant Clinical Oncologist at Leeds Teaching Hospitals NHS Trust, noted: "The approval of durvalumab for limited-stage small cell lung cancer marks a major step forward in the treatment of this difficult disease. Historically, patients with this form of lung cancer have had very few treatment options, with outcomes often remaining poor despite intensive therapy. The ADRIATIC trial shows that the addition of immunotherapy can significantly extend survival."
Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, highlighted the long-awaited progress: "This decision offers a huge step forward for people diagnosed with limited-stage small cell lung cancer, a disease where progress has been desperately overdue. For more than two decades, patients with this form of lung cancer have faced the same treatment options with little change in outcomes."
The approval represents a significant milestone for patients with limited-stage SCLC, who typically face a poor prognosis with only 15-30% surviving five years post-diagnosis. Although initial responses to chemoradiotherapy are common, recurrence is rapid, making the availability of an effective maintenance therapy particularly valuable for this patient population.
