Three-year OS follow-up from CASPIAN trial

The phase 3 CASPIAN trial demonstrated first-line treatment with durvalumab/platinum-etoposide to improve overall survival (OS) versus etoposide alone in patients with extensive stage small-cell lung cancer (ES-SCLC). Three-year median follow-up demonstrated sustained OS benefit.

Recently, the phase 3 CASPIAN trial (NCT03043872) demonstrated first-line treatment of ES-SCLC with durvalumab plus etoposide to improve OS versus etoposide alone (HR 0.73; P=0.0047) [1]. This benefit was sustained with more than 2 years follow-up [2]. In addition, a numerical, not statistically significant improvement in OS was observed with durvalumab plus tremelimumab plus etoposide versus etoposide alone [2].

Updated OS results of CASPIAN after a median of more than 3 years follow-up were presented by Dr Luis Paz-Ares (Hospital Universitario 12 de Octubre, Spain). In CASPIAN, 805 patients with treatment-naïve ES-SCLC were randomised 1:1:1 to durvalumab/etoposide (every 3 weeks), durvalumab/tremelimumab/etoposide (every 3 weeks), or etoposide (every 3 weeks, 6 cycles). Patients in the immunotherapy arms received 4 cycles of etoposide/durvalumab ± tremelimumab, followed by maintenance durvalumab (every 4 weeks). The primary endpoints were OS for durvalumab/etoposide versus etoposide and for durvalumab/tremelimumab/etoposide versus etoposide.

At a median follow-up of 39.4 months (86% maturity), durvalumab/etoposide continued to demonstrate improved OS versus etoposide (HR 0.71; P=0.0003). Median OS was 12.9 versus 10.5 months. At 24 months, 22.9% versus 13.9% of patients were alive, and at 36 months 17.6% versus 5.8% of patients were alive with durvalumab/etoposide versus etoposide, respectively (see Figure).

Figure: 3-year overall survival update of CASPIAN [3]



Durvalumab/tremelimumab/etoposide also continued to improve OS versus etoposide (HR 0.81; P=0.02). Median OS was 10.4 months versus 10.5 months. At 24 months, 22.9% versus 13.9% of patients were alive, and at 36 months 15.3% and 5.8% of patients were alive with durvalumab/tremelimumab/etoposide versus etoposide alone, respectively.

Safety profiles were consistent with previous analyses. “Three times more patients were estimated to be alive at 3 years follow-up when treated with durvalumab/etoposide versus etoposide alone, further establishing durvalumab/etoposide as standard of care for first-line treatment of ES-SCLC,” concluded Dr Paz-Ares. “Addition of tremelimumab to durvalumab/etoposide does not further improve OS.”

1. Paz-Ares L, et al. 2019;394:1929-1939.
2. Goldman JW, et al. Lancet Oncol. 2021;22:51–65.
3. Paz-Ares L, et al. Durvalumab ± tremelimumab + platinum-etoposide in first-line extensive-stage SCLC (ES-SCLC): 3-year overall survival update from the phase III CASPIAN study. Abstract LBA61, ESMO Congress 2021, 16–21 September.

 

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Posted on 19 November 202125 March 2024