Dr Brahmer on First-line Tremelimumab/Durvalumab Plus Chemotherapy in NSCLC

Julie Renee Brahmer, MD, co-director, the Upper Aerodigestive Department, the Bloomberg-Kimmel Institute for Cancer Immunotherapy, professor of Oncology, Johns Hopkins Medicine, discusses the use of tremelimumab-actl (Imjudo) plus durvalumab (Imfinzi) and platinum-based chemotherapy for the first-line treatment of patients with non–small cell lung cancer (NSCLC), and how decisions can be made between this regimen and nivolumab (Opdivo) plus ipilimumab (Yervoy) and chemotherapy.

In November 2022, the FDA approved tremelimumab plus durvalumab and platinum-based chemotherapy for patients with metastatic NSCLC without sensitizing EGFR mutation or ALK aberrations. The approval was supported by data from the phase 3 POSEIDON trial (NCT03164616), which showed that the combination generated a median overall survival of 14 months (95% CI, 11.7-16.1) vs 11.7 months (95% CI, 10.5-13.1) for chemotherapy alone, translating to a 23% reduction in the risk of death (HR, 0.77; 95% CI, 0.65-0.92; 2-sided P = .00304).

This represented the approval of another chemoimmunotherapy combination after the regulatory agency gave the green light to nivolumab plus ipilimumab and 2 cycles of platinum-doublet chemotherapy for the frontline treatment of patients with metastatic or recurrent NSCLC) with no EGFR or ALK aberrations in May 2020. One of the benefits of the tremelimumab/durvalumab regimen is that patients can continue on chemotherapy beyond 2 cycles while receiving tremelimumab and durvalumab for 4 cycles, before durvalumab is continued alone, Brahmer says. This can beneficial for clinicians who feel certain patients may benefit from receiving a longer duration of chemotherapy in addition to immunotherapy, Brahmer notes.

Both regimens have a place in the first-line treatment paradigm for NSCLC, and the longer chemotherapy duration associated with tremelimumab/durvalumab can let clinicians to decide between the 2 regimens to make a decision based on an individual patient’s needs, Brahmer concludes.