# Perioperative durvalumab for resectable non-small-cell lung cancer

Source: https://onco.cc/key-papers/paper-heymach-aegean-perioperative-durvalumab-nejm-2023/  
OnCo record `paper-heymach-aegean-perioperative-durvalumab-nejm-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving immunotherapy both before and after lung cancer surgery cut the risk of recurrence by about a third, and left 17.2 percent of tumours with no viable cancer at all in the specimen.

## Summary

The AEGEAN investigators, reported by Heymach, Harpole, Mitsudomi and colleagues, randomised 802 patients with resectable stage II to IIIB (N2) non-small-cell lung cancer to platinum chemotherapy with durvalumab or placebo for four cycles before surgery, followed by durvalumab or placebo every four weeks for twelve cycles afterwards. Patients with EGFR or ALK alterations were excluded from the efficacy analyses.

AEGEAN, KEYNOTE-671 and CheckMate 77T all give immunotherapy on both sides of the operation, and CheckMate 816 gives it only before. None of them has been compared against the others, so which of the four schedules is best remains the largest unanswered question in early-stage lung cancer.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: New England Journal of Medicine
- Year: 2023
- DOI: 10.1056/NEJMoa2304875
- Authors: Heymach JV, Harpole D, Mitsudomi T, et al.
- Findings: Event-free survival was significantly longer with durvalumab: stratified hazard ratio for disease progression, recurrence or death 0.68 (95 percent confidence interval 0.53 to 0.88; P equals 0.004) at the first interim analysis.; At the 12-month landmark, event-free survival was 73.4 percent with durvalumab (67.9 to 78.1) against 64.5 percent with placebo (58.8 to 69.6).; Pathological complete response 17.2 percent against 4.3 percent at the final analysis: difference 13.0 percentage points (8.7 to 17.6).; 802 patients were randomised, 400 to durvalumab and 402 to placebo.; In the 2026 updated report (median follow-up 25.9 months) the event-free survival hazard ratio remained 0.69 (0.55 to 0.88), with disease-free survival 0.66 (0.47 to 0.92) and overall survival 0.89 (0.70 to 1.14).
- What it means: Perioperative immunotherapy is now standard for resectable lung cancer without a targetable driver. The updated overall survival hazard ratio of 0.89, with a confidence interval crossing one, is the honest state of the evidence on whether it cures more people.
- Caveats: Event-free survival and pathological complete response are the endpoints; overall survival remains numerically favourable but not significant in the updated analysis.; Patients with EGFR or ALK alterations were excluded from efficacy analyses, and those patients are now treated with targeted adjuvant therapy instead.; Adjuvant durvalumab is given to everybody, including patients already cured by surgery and chemotherapy, and the contribution of the adjuvant half of the regimen has never been isolated.

## Sources

- N Engl J Med 2023: https://doi.org/10.1056/NEJMoa2304875
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37870974/
- Updated outcomes, J Clin Oncol 2026: https://doi.org/10.1200/JCO-25-02659
- ClinicalTrials.gov NCT03800134: https://clinicaltrials.gov/study/NCT03800134

## Connected records

- key papers: [Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010)](https://onco.cc/key-papers/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021/), [CheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgery](https://onco.cc/key-papers/paper-checkmate-816-nejm-2022/), [Perioperative nivolumab and chemotherapy in stage III non-small-cell lung cancer](https://onco.cc/key-papers/paper-provencio-nadim-ii-perioperative-nivolumab-stage-iii-nejm-2023/), [Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer](https://onco.cc/key-papers/paper-keynote-671-n-engl-j-med-2023/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Durvalumab](https://onco.cc/drugs/durvalumab/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- terms: [Immune checkpoint](https://onco.cc/terms/immune-checkpoint/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/)
- people: [John V. Heymach](https://onco.cc/people/john-heymach/), [Martin Reck](https://onco.cc/people/martin-reck/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/), [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- roadmaps: [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)

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