Dr. Goldman on Key Takeaways From the CASPIAN Trial in Frontline ES-SCLC

Jonathan W. Goldman, MD, hematologist and oncologist, UCLA Medical Center, discusses key takeaways from the phase 3 CASPIAN trial (NCT03043872) in patients with extensive-stage small cell lung cancer (ES-SCLC).

CASPIAN examined the use of durvalumab (Imfinzi) in combination with etoposide and either carboplatin or cisplatin, or durvalumab and chemotherapy with the addition of tremelimumab vs chemotherapy alone in the frontline treatment of patients with ES-SCLC.

Results from the study showed no overall survival benefit with the 4-drug regimen. However, a median OS benefit of approximately 2.5 months was observed with the 3-drug regimen vs chemotherapy alone, translating to a hazard ratio of 0.75. The regimens were also found to have favorable safety profiles, according to Goldman. The addition of immunotherapy to the chemotherapy backbone did not come at the cost of significant toxicity.

Some immunotherapy-related toxicities were observed in the durvalumab arm, but most were manageable endocrine disorders, Goldman says. The OS data, along with the quality-of-life benefit of delayed worsening of symptoms, support durvalumab plus chemotherapy as a standard-of-care treatment in the first-line setting for this population, Goldman concludes.