FDA grants priority review to Imfinzi with chemotherapy for advanced biliary tract cancer
Click Here to Manage Email Alerts
The FDA granted priority review to durvalumab plus chemotherapy for treatment of locally advanced or metastatic biliary tract cancer.
Durvalumab (Imfinzi, AstraZeneca) — a PD-L1 checkpoint inhibitor — is approved in the United States for treatment of patients with unresectable stage III non-small cell lung cancer whose disease has not progressed after chemoradiotherapy. It also is approved for treatment of extensive-stage small cell lung cancer.
The FDA based priority review of the biliary tract cancer indication on results of the randomized phase 3 TOPAZ-1 trial.
The international, double-blind trial included 685 patients previously untreated for unresectable locally advanced, recurrent or metastatic biliary tract cancer.
Researchers randomly assigned the patients 1:1 to gemcitabine and cisplatin with either 1,500 mg durvalumab every 3 weeks (n = 341; median age, 64 years; range, 20-84; 50.4% women) or placebo (n = 344; median age, 64 years; range, 31-85; 48.8% women).
Patients received 1,000 mg/m2 and 25 mg/m2 cisplatin on days 1 and 8 every 3 weeks for up to eight cycles, after which they continued to receive 1,500 mg durvalumab every 4 weeks or placebo until disease progression or unacceptable toxicity.
OS served as the primary objective; secondary endpoints included PFS, objective response rate and safety.
As Healio previously reported, results presented at ASCO Gastrointestinal Cancers Symposium showed durvalumab plus chemotherapy conferred a statistically significant improvement in OS (median, 12.8 months vs. 11.5 months; HR = 0.8; 95% CI, 0.66–0.97) and PFS (median, 7.2 months vs. 5.7 months; HR = 0.75; 95% CI, 0.64–0.89) compared with placebo and chemotherapy.
The durvalumab group also had a higher rate of 2-year OS (24.9% vs. 10.4%) and a higher ORR (26.7% vs. 18.7%), and lower rates of grade 3 to grade 4 treatment-related adverse events (62.7% vs. 64.9%) and adverse events that led to discontinuation of any study medication (8.9% vs. 11.4%).
The FDA is expected to make a decision on approval for this indication in the third quarter of this year.