A trial of durvalumab for non small cell lung cancer (ATLANTIC)

Cancer type:

Lung cancer

Small cell lung cancer

Status:

Results

Phase:

Phase 2

This trial looked at durvalumab for people who have had treatment for non small cell lung cancer (NSCLC) but the cancer has continued to grow.

More about this trial

Doctors often treat non small cell lung cancer that has spread with radiotherapy, chemotherapy or targeted cancer drugs.

Durvalumab (MEDI4736) is a type of targeted cancer treatment called a monoclonal antibody. It seeks out cancer cells by looking for a particular protein and attaching to it.

The researchers hoped that durvalumab would help the immune system to recognise and attack cancer cells, stopping the cancer growing.

The main aim of this trial was to find out if durvalumab helps stimulate the immune system and helps stop non small cell lung cancer growing

Summary of results

The research team found that durvalumab could be a useful treatment for advanced non small cell lung cancer and didn’t cause too many side effects.

This trial was open for people to join between 2014 and 2015, and the research team published the results in 2018.

About this trial

Everyone taking part in this trial had non small cell lung cancer (NSCLC) that had spread (advanced cancer). They’d had at least 2 courses of treatment already, but their cancer had started to grow again.

People taking part were put into 1 of 3 groups depending on two factors.

The first was whether they had changes in genes called EGFR or ALK or not.

The second was whether there was a protein called PD-L1 on the surface of their cancer cells or not. When cells have the PD-L1 protein, it is called PD-L1 expression. Other research had shown that treatments similar to durvalumab work better when more of the cancer cells express the PD-L1 protein.

The 3 treatment groups were:

Group 1 – people who had a change in their EGFR or ALK gene, and some of their cancer cells expressed PD-L1
Group 2 – people who didn’t have a change in their EGFR or ALK gene, and some of their cancer cells expressed PD-L1
Group 3 – people who didn’t have a change in their EGFR or ALK gene, and more than 90% of their cancer cells expressed PD-L1

Everyone taking part had durvalumab through a drip into a vein, once every 2 weeks for up a year.

Results

A total of 444 people joined this trial. They were put into 1 of the 3 groups depending on their genetic changes and PD-L1 protein. There were:

111 people in group 1 - EGFR or ALK change and some of their cancer cells expressed PD-L1
265 people in group 2 - no EGFR or ALK change and some of their cancer cells expressed PD-L1
68 people in group 3 - no EGFR or ALK change and a high number of their cancer cells expressed PD-L1

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The research team looked at how well the treatment worked in 409 of the people who took part.

First, they looked at people with less than 25% of cancer cells which expressed PD-L1. The cancer got a bit smaller in:

4% in group 1
8% in group 2

Next they looked at people with more than 25% of cancer cells which expressed PD-L1. The cancer got a bit smaller in:

12% in group 1
16% in group 2
31% in group 3

Then they looked at people with more than 90% of cancer cells which produced PD-L1. The cancer got a bit smaller in:

16% in group 1
23% in groups 2 and 3

These results show that durvalumab seems to work better for people with more cells that express the PD-L1 protein. And for those who don’t have a change in their EGFR or ALK genes.

They also found that people who had more than 25% of cancer cells which expressed PD-L1 lived longer than those who had less than 25%. This was the case whether people had a change in their genes or not.

Side effects

Just over half the people taking part (58%) had at least one side effect. Most were mild or didn’t last long. But 27 people (6%) had side effects that were more severe.

The most common of the more severe side effects were:

inflammation of the lungs (pneumonitis)
extreme tiredness (fatigue)
a reaction to the drug which can cause symptoms such as rash or fever (infusion reaction)

Conclusion

The research team concluded that durvalumab could be a useful treatment for non small cell lung cancer that had spread. They also concluded that it didn’t cause too many side effects.

It seemed to work best for people who didn’t have a change in their EGFR or ALK genes, and if more than 25% of their cancer cells expressed PD-L1. The team suggest it is looked at in further trials.

Where this information comes from

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.