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ADRIATIC gave immunotherapy after chemoradiotherapy for limited-stage small-cell lung cancer and lifted median survival from 33.4 to 55.9 months, the largest gain the disease has seen.
The ADRIATIC investigators, reported by Cheng, Spigel, Cho and colleagues with Senan as senior author, randomised patients with limited-stage small-cell lung cancer who had not progressed after concurrent platinum-based chemoradiotherapy to durvalumab 1500 mg (264), durvalumab with tremelimumab 75 mg (200) or placebo (266), every four weeks for up to 24 months. Randomisation was stratified by disease stage and receipt of prophylactic cranial irradiation, and the durvalumab-tremelimumab group remained blinded at this report.
It is the PACIFIC design transplanted into small-cell disease, and it worked better. A 22-month gain in median overall survival is without precedent in this cancer.
The biggest single advance in small-cell lung cancer since twice-daily radiotherapy in 1999, and the strongest argument that the disease responds to immunotherapy when it is given at a lower tumour burden.
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.
The standard of care in limited-stage small-cell lung cancer from 1999 until ADRIATIC added immunotherapy in 2024, and a rare example of a curative gain in a disease that has had almost none.
Shares Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide, Prophylactic cranial irradiation vs MRI surveillance, Limited-stage small-cell lung cancer, Radiotherapy and the tag lung-evidence.
Shares Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer, Radiotherapy, 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, Chemoradiation (chemoradiotherapy, CRT) and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, Durvalumab and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, PD-1 and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, Biomarkers are not validated or standardised and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, Biomarkers are not validated or standardised and the tag lung-evidence.
Shares Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN), Limited-stage small-cell lung cancer, 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, Rare and paediatric cancers without markets and the tag lung-evidence.
Shares Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN), 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, Rare and paediatric cancers without markets, New England Journal of Medicine and the tag lung-evidence.