{"entity":{"id":"paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019","kind":"paper","name":"Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN)","aka":[],"tldr":"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).\n\nWith 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.","asOf":"2026-09-25","links":[{"label":"Lancet 2019","url":"https://doi.org/10.1016/S0140-6736(19)32222-6"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/31590988/"},{"label":"ClinicalTrials.gov NCT03043872","url":"https://clinicaltrials.gov/study/NCT03043872"}],"tags":["lung-evidence"],"related":["paper-impower133-n-engl-j-med-2018","paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024","paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023"],"cancers":["lung-cancer","sclc","extensive-stage-sclc"],"sections":["immunotherapy"],"technologies":["checkpoint-inhibitor"],"targets":["pd1"],"drugs":["durvalumab","tremelimumab","etoposide","cisplatin","carboplatin","atezolizumab"],"companies":["astrazeneca"],"institutions":[],"pathways":["immune-checkpoint"],"terms":["pdl1","prophylactic-cranial-irradiation"],"trials":["caspian","impower133"],"people":["luis-paz-ares"],"bottlenecks":["b-immunotherapy-response","b-biomarker-validation","b-rare-cancers"],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2019,"doi":"10.1016/S0140-6736(19)32222-6","pmid":"31590988","authors":"Paz-Ares L, Dvorkin M, Chen Y, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":537},"route":"/key-papers/paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019/","neighbours":{"paper":[{"id":"paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024","kind":"paper","name":"Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer","route":"/key-papers/paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024/"},{"id":"paper-impower133-n-engl-j-med-2018","kind":"paper","name":"First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer","route":"/key-papers/paper-impower133-n-engl-j-med-2018/"},{"id":"paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023","kind":"paper","name":"Tarlatamab for patients with previously treated small-cell lung cancer","route":"/key-papers/paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023/"}],"cancer":[{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"prophylactic-cranial-irradiation","kind":"technology","name":"Prophylactic cranial irradiation vs MRI surveillance","route":"/technologies/prophylactic-cranial-irradiation/"}],"target":[{"id":"pd1","kind":"target","name":"PD-1","route":"/targets/pd1/"},{"id":"pdl1","kind":"target","name":"PD-L1","route":"/targets/pdl1/"}],"drug":[{"id":"atezolizumab","kind":"drug","name":"Atezolizumab","route":"/drugs/atezolizumab/"},{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"durvalumab","kind":"drug","name":"Durvalumab","route":"/drugs/durvalumab/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"tremelimumab","kind":"drug","name":"Tremelimumab","route":"/drugs/tremelimumab/"}],"company":[{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"}],"term":[{"id":"immune-checkpoint","kind":"term","name":"Immune checkpoint","route":"/terms/immune-checkpoint/"}],"trial":[{"id":"caspian","kind":"trial","name":"CASPIAN","route":"/trials/caspian/"},{"id":"impower133","kind":"trial","name":"IMpower133","route":"/trials/impower133/"}],"person":[{"id":"luis-paz-ares","kind":"person","name":"Luis Paz-Ares","route":"/people/luis-paz-ares/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-immunotherapy-response","kind":"bottleneck","name":"No one can predict who responds to immunotherapy","route":"/bottlenecks/b-immunotherapy-response/"},{"id":"b-rare-cancers","kind":"bottleneck","name":"Rare and paediatric cancers without markets","route":"/bottlenecks/b-rare-cancers/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}],"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"idea":[{"id":"idea-lung-small-cell-platform-with-shared-controls-and-subtypes","kind":"idea","name":"Run small-cell lung cancer as one platform with shared controls and subtype stratification","route":"/ideas/idea-lung-small-cell-platform-with-shared-controls-and-subtypes/"}]}}