Addition of durvalumab to nab-paclitaxel may benefit patients with lung cancer

MADRID — The addition of durvalumab to nab-paclitaxel slightly improved PFS and also improved response rates among patients with nonsquamous non-small cell lung cancer, according to results of a comparative study presented at the European Society for Medical Oncology Congress.

Researchers also reported manageable toxicities with the regimen.

“The treatment of nonsquamous non-small cell lung cancer is evolving with the advent of immune checkpoint inhibitors, but prolonged benefit from this therapy is uncommon and the majority of patients eventually require additional chemotherapy,” Daniel Morgensztern, MD, associate professor of medical oncology at Washington University School of Medicine, said during his presentation.

In the ABOUND.2L+ trial, Morgensztern and colleagues assessed nab-paclitaxel as a single agent, as well as in combination with oral azacytidine (CC-486, Celgene) — an investigational DNA methyltransferase inhibitor — or the PD-L1 inhibitor durvalumab (Imfinzi, AstraZeneca).

The analysis included 240 patients, of whom 80 (median age, 63 years; 50% men) received nab-paclitaxel alone, 79 (median age, 63 years; 54% men) received nab-paclitaxel plus durvalumab, and 81 (median age, 65 years, 50% men) received nab-paclitaxel plus CC-486.

Treatment for all patients continued until unacceptable toxicity or tumor progression.

Grade 3 or grade 4 treatment-related adverse events occurred at rates of 54.4% among patients who received nab-paclitaxel monotherapy and 59.5% among patients who received nab-paclitaxel plus CC-486.

The most frequent grade 3 to grade 4 hematologic events in these groups included neutropenia (10.1% for nab-paclitaxel alone vs. 16.5% for CC-486 regimen) and anemia (7.6% vs. 1.3%). Grade 3 or grade 4 peripheral neuropathy occurred in 7.6% of patients treated with nab-paclitaxel alone and 2.5% among those who also received CC-486.

Toxicity data for patients who received nab-paclitaxel plus durvalumab were not available at the time of Morgensztern’s presentation.

Compared with patients who received nab-paclitaxel monotherapy, those who also received CC-486 achieved shorter median PFS (3.2 months vs. 4.2 months) and OS (8.4 months vs. 12.7 months). Overall response rates were 13.8% in the CC-486 group and 13.6% among those who received nab-paclitaxel alone.

Preliminary data for patients who received nab-paclitaxel plus durvalumab showed median PFS of 4.4 months. Median OS was not yet estimable, and researchers reported a 20% ORR.

“We are hoping results of ongoing trials such as J-AXEL will provide further insight into the role of nab-paclitaxel in patients with previously treated advanced nonsquamous non-small cell lung cancer,” Morgensztern said. – by Chuck Gormley

Reference:

Morgensztern D, et al. Abstract LBA48. Presented at: European Society for Medical Oncology Congress; Sept. 8-12, 2017; Madrid.

Disclosures: Celgene funded this study. Morgensztern reports consultant roles with Celgene, AbbVie and Bristol-Myers Squibb. Please see the abstract for a list of all other researchers’ relevant financial disclosures.