# Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN)

Source: https://onco.cc/key-papers/paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019/  
OnCo record `paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding immunotherapy to chemotherapy for advanced small-cell lung cancer raised median survival from 10.3 to 13.0 months. Small, but it was the second positive first-line trial in the disease in thirty years.

## Summary

The CASPIAN investigators, reported by Paz-Ares, Dvorkin, Chen and colleagues, randomised treatment-naive patients with extensive-stage small-cell lung cancer 1 to 1 to 1 across 209 sites in 23 countries to durvalumab with platinum and etoposide, durvalumab with tremelimumab and platinum-etoposide, or platinum-etoposide alone. The interim analysis reported here compares the durvalumab arm (268 patients) with chemotherapy alone (269).

With IMpower133 the year before, CASPIAN ended a thirty-year drought in extensive-stage small-cell lung cancer. The honest reading is that both trials moved median survival by two to three months in a disease where almost nobody is alive at three years, which is why the field moved on to DLL3 and the transcription-factor subtypes.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: The Lancet
- Year: 2019
- DOI: 10.1016/S0140-6736(19)32222-6
- Authors: Paz-Ares L, Dvorkin M, Chen Y, et al.
- Findings: Median overall survival 13.0 months (95 percent confidence interval 11.5 to 14.8) with durvalumab plus platinum-etoposide against 10.3 months (9.3 to 11.2) with platinum-etoposide: hazard ratio 0.73 (0.59 to 0.91; p equals 0.0047).; 34 percent (26.9 to 41.0) against 25 percent (18.4 to 31.6) of patients alive at 18 months.; Grade 3 or 4 adverse events of any cause in 163 of 265 treated patients (62 percent) with durvalumab and 166 of 266 (62 percent) with chemotherapy alone.; Adverse events leading to death in 13 (5 percent) and 15 (6 percent) patients.
- What it means: Immunotherapy is now part of first-line treatment for extensive-stage small-cell lung cancer everywhere, on the strength of a gain measured in weeks. The size of that gain is the reason small-cell lung cancer remains the clearest unmet need in thoracic oncology.
- Caveats: Interim analysis; the tremelimumab arm was still blinded and later did not add benefit.; No predictive biomarker: PD-L1 does not select responders in small-cell lung cancer, so everyone is treated and a minority benefits.; Prophylactic cranial irradiation was allowed only in the chemotherapy arm at investigator discretion, an asymmetry in the design.

## Sources

- Lancet 2019: https://doi.org/10.1016/S0140-6736(19)32222-6
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31590988/
- ClinicalTrials.gov NCT03043872: https://clinicaltrials.gov/study/NCT03043872

## Connected records

- key papers: [Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer](https://onco.cc/key-papers/paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024/), [First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer](https://onco.cc/key-papers/paper-impower133-n-engl-j-med-2018/), [Tarlatamab for patients with previously treated small-cell lung cancer](https://onco.cc/key-papers/paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023/)
- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Prophylactic cranial irradiation vs MRI surveillance](https://onco.cc/technologies/prophylactic-cranial-irradiation/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Etoposide](https://onco.cc/drugs/etoposide/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- terms: [Immune checkpoint](https://onco.cc/terms/immune-checkpoint/)
- trials: [CASPIAN](https://onco.cc/trials/caspian/), [IMpower133](https://onco.cc/trials/impower133/)
- people: [Luis Paz-Ares](https://onco.cc/people/luis-paz-ares/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- 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/)
- ideas: [Run small-cell lung cancer as one platform with shared controls and subtype stratification](https://onco.cc/ideas/idea-lung-small-cell-platform-with-shared-controls-and-subtypes/)

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