Imfinzi becomes first NHS drug for aggressive lung cancer

AstraZeneca's immunotherapy Imfinzi is the first drug therapy to be recommended for routine NHS use as a treatment for limited-stage small cell lung cancer (LS-SCLC), a particularly hard-to-treat disease.

PD-L1 inhibitor Imfinzi (durvalumab) has been given the green light for the treatment of LS-SCLC that has not progressed after concurrent platinum-based chemotherapy and radiation therapy (CRT), making it an option for around 530 people in England from today.

SCLC is less common than non-small cell lung cancer (NSCLC), making up around 15% of all lung cancer cases. Around 30% of SCLC diagnoses come when the tumour is confined to one lung or one side of the chest, defining it as LS-SCLC.

First-line CRT can lead to a high level of response and be curative in some cases, but relapses are frequent and only around a quarter of patients live for five years from diagnosis.

The endorsement by health technology assessment (HTA) authority NICE comes on the back of positive results in the ADRIATIC study last year, which showed that Imfinzi extended the median overall survival (OS) time for patients from 33.4 months with placebo to 55.9 months, a 27% improvement.

Imfinzi also reduced the risk of disease progression or death by 24%, with the median progression-free survival (PFS) of 16.6 months versus 9.2 months in the control group. All told, 57% of patients were still alive at three years after being treated with AZ's drug.

There are no standard treatments for people with limited-stage SCLC that has not progressed after CRT, with only active monitoring of the disease offered, according to NICE. Surgery may also be an option for some people with early SCLC, but this is not feasible for many people with the disease, as it is usually diagnosed at a later stage.

"This decision offers a huge step forward for people diagnosed with limited-stage small cell lung cancer, a disease where progress has been desperately overdue," commented Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation.

"For more than two decades, patients with this form of lung cancer have faced the same treatment options with little change in outcomes. Now, there is a treatment that can extend survival and give people more precious time with their loved ones."

Imfinzi is also approved as a first-line treatment for extensive-stage SCLC, amongst other cancers, and was backed by NICE for that indication in January.

The investigator-led NRG-LU005 study, sponsored by the National Cancer Institute (NCI), is also looking at Roche's PD-L1 inhibitor Tecentriq (atezolizumab) as a treatment for limited-stage SCLC, with results due in 2026.