Written By: David Statman
Durvalumab (Imfinzi) for Mesothelioma
Durvalumab, brand name Imfinzi, is an immunotherapy drug used in the treatment of malignant mesothelioma. It belongs to a class of medication known as immune checkpoint inhibitors. Durvalumab works by helping the immune system detect and attack cancer cells.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Important Facts About Durvalumab for Mesothelioma
- Durvalumab is not yet approved by the U.S. Food and Drug Administration (FDA) for malignant mesothelioma. It is currently in clinical trial testing for pleural mesothelioma.
- Durvalumab is being studied as a combination therapy with chemotherapy. It has shown promising survival outcomes for mesothelioma patients compared to using chemotherapy alone.
- The immunotherapy drug focuses on blocking the binding of PD-1 and PD-L1 protein receptors. When these protein receptors connect, they suppress the immune system.
- The phase II DREAM study involving durvalumab showed encouraging overall survival results that led to a larger phase III DREAM3R study.
What Is Durvalumab?
Durvalumab is an emerging immunotherapy cancer treatment designed to help the immune system recognize and attack cancer cells more effectively. Manufactured by AstraZeneca, this drug is marketed under the brand name Imfinzi.
Durvalumab works by targeting the PD-L1 protein found on the surface of many cancer cells, including some mesothelioma cells. PD-L1 helps cancer cells evade detection by the immune system. By blocking PD-L1 proteins, durvalumab allows the body’s immune defenses to better identify and attack cancer cells.
The FDA approved durvalumab for the treatment of both non-small cell and small cell lung cancer. Researchers have also been investigating the drug as a potential treatment for pleural mesothelioma due to the similarities between the two diseases. These cancers are often compared due to their location: pleural mesothelioma develops in the pleural lining surrounding the lungs.
How Does Durvalumab Work for Mesothelioma?
Mesothelioma is an aggressive form of cancer. It can spread quickly due to the cancer’s ability to avoid the body’s natural immune system defenses. Durvalumab is an immunotherapy drug that works as a therapeutic counter to slow or stop the growth of mesothelioma.
The immunotherapy targets two proteins involved in suppressing the immune response. PD-1 is a protein receptor found on the surface of T-cells, while PD-L1 is a protein often found on the surface of mesothelioma cells. Durvalumab blocks PD-L1 from binding to PD-1, helping the immune system recognize and attack cancer cells.
This is how durvalumab works as a mesothelioma treatment:
- Suppressing the immune system — When the PD-1 proteins and PD-L1 receptors connect, the immune system mistakes mesothelioma cells as safe and normal. The receptors trick the body into accepting the presence of mesothelioma cells, blocking an immune response.
- Inserting a blockade — Durvalumab targets the PD-L1 proteins on mesothelioma cells. The drug acts as a wall, or blockade, between the proteins and the receptors.
- Improving immune response — Once PD-1 and PD-L1 are blocked from connecting, the immune system’s T-cells can identify mesothelioma cells as a dangerous invader and begin attacking them. This helps the immune system remain active against mesothelioma cells.
Administration of Durvalumab
While not yet approved for mesothelioma, the FDA’s approval for lung cancer offers some insight into a future recommendation for mesothelioma.
According to the FDA website:
- Durvalumab is administered intravenously over 60 minutes.
- Patients receive durvalumab every three weeks on the same day as chemotherapy treatment, or every four weeks if not receiving chemotherapy.
How to Receive Durvalumab for Mesothelioma
Since the FDA has not approved durvalumab for mesothelioma, access is restricted to clinical trials. Here are a few steps to learn more about receiving durvalumab before the FDA signs off on the therapy:
- Contact a mesothelioma patient advocate. A mesothelioma advocate can help you find a list of ongoing clinical trials that are accepting patients around the country.
- Look up the side effects of durvalumab. Before considering any medication, it is important to understand the risks and benefits of the treatment. It is also important to know that not all treatments are appropriate for every type of mesothelioma.
- Sign up for a clinical trial. With the help of an experienced patient advocate, you can find a recruiting trial using durvalumab, receive valuable information about the treatment and connect with the clinical trial team to start the evaluation process.
Survival Rates of Durvalumab for Mesothelioma
Mesothelioma survival from durvalumab is impressive but based solely on clinical trials. A few studies emphasize the drug’s strong potential as a mesothelioma treatment. According to data from two studies, the median survival for durvalumab is 16-20 months.
Durvalumab Studies and Ongoing Clinical Trials
DREAM was a phase 2 clinical trial that studied durvalumab plus chemotherapy for mesothelioma. Researchers tested durvalumab with chemotherapy and compared the results to patients receiving only chemotherapy.
The FDA approved chemotherapy (pemetrexed and either cisplatin or carboplatin) for the treatment of mesothelioma. Many trials seeking approval will compare their new therapy findings to the results achieved with chemotherapy.
In the DREAM clinical trial, the combination of durvalumab plus chemotherapy had a median survival of 20.4 months. This outperformed chemotherapy by 6-8 months.
Other statistics from the study:
- 56.4% partial response, meaning the cancer retreated/shrank
- 40% stable disease, meaning the cancer neither grew nor shrank
- 70.4% one-year survival rate
- 44.2% two-year survival rate
- 69% progression-free survival at six months (meaning the disease hadn’t grown)
- No unexpected side effects, and the expected side effects were manageable
The results of the clinical trial exceeded the expected safety and clinical standards, which supported the advancement to a phase 3 confirmation trial.
DREAM3R Clinical Trial
The encouraging results of the DREAM trial led researchers to develop the phase 3 DREAM3R trial. The phase 3 study would further evaluate the effectiveness of durvalumab combined with chemotherapy in patients with pleural mesothelioma.
This was a randomized study where two-thirds of the participants received durvalumab plus chemotherapy (pemetrexed and either cisplatin or carboplatin), and the other one-third received chemotherapy alone. Unfortunately, this study ended early due to the change in standards of care for the treatment of mesothelioma, resulting in inconclusive results.
In 2020, the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for the treatment of unresectable malignant pleural mesothelioma as a result of the CheckMate 743 study. This study showed evidence that the Opdivo and Yervoy duo improved overall survival compared to chemotherapy.
This newly approved treatment regimen resulted in oncologists and professional organizations like the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) updating their standards of care and adopting the new immunotherapy treatment in standard clinical practice.
Durvalumab and Tremelimumab
Another phase 2 clinical study, NIBIT-MESO-1, used durvalumab paired with tremelimumab, two checkpoint inhibitors. Tremelimumab works by blocking CTLA-4 receptors on T-cells while durvalumab blocks PD-L1 proteins found on cancer cells. This dual-checkpoint approach was designed to strengthen the immune response against mesothelioma tumors.
Results from that study:
- Median survival was 16.5 months for 40 patients
- 20% survived for three years
- 15% survived for four years
Side Effects of Durvalumab
Durvalumab is often well tolerated, but like all immunotherapy drugs, it can cause side effects that range from mild to more severe. The common side effects include:
- Loss of appetite
- Fatigue
- Fever
- Nausea
- Shortness of breath
Serious side effects are less common, but durvalumab works by activating the immune system which can cause severe inflammation in the lungs, liver, intestines, kidneys or thyroid.
All side effects should be reported to the doctor immediately. Most are manageable if identified and treated promptly.
Sources & Author
- Tremelimumab plus durvalumab retreatment and 4-year outcomes in patients with mesothelioma: a follow-up of the open label, non-randomised, phase 2 NIBIT-MESO-1 study. The Lancelet. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33844995/. Accessed: 06/24/2026.
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Durvalumab added to standard chemotherapy improved overall survival in mesothelioma. The ASCO Post. Retrieved from:
https://ascopost.com/news/june-2020/durvalumab-added-to-standard-chemotherapy-improved-os-in-patients-with-malignant-pleural-mesothelioma/. Accessed: 06/24/2026. -
Phase 3 DREAM3R trial opens for malignant pleural mesothelioma. Medical News. Retrieved from: https://www.news-medical.net/news/20210317/Phase-3-DREAM3R-trial-opens-for-malignant-pleural-mesothelioma.aspx. Accessed: 06/24/2026.
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DuRvalumab With chEmotherapy as First Line treatment in Advanced Pleural Mesothelioma (DREAM3R). Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04334759. Accessed: 06/24/2026.
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Durvalumab (Intravenous Route). Mayo Clinic. Retrieved from: https://www.mayoclinic.org/drugs-supplements/durvalumab-intravenous-route/side-effects/drg-20406270. Accessed: 06/24/2026.
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FDA approves durvalumab for extensive-stage small cell lung cancer. American Society of Clinical Oncology. Retrieved from: https://www.asco.org/practice-policy/policy-issues-statements/asco-in-action/fda-approves-durvalumab-extensive-stage. Accessed: 06/24/2026.
AI Summary of Durvalumab (Imfinzi) for Mesothelioma
Durvalumab, also known by its brand name Imfinzi, is an emerging immunotherapy treatment that shows promise in fighting malignant mesothelioma, a rare and aggressive cancer often linked to asbestos exposure. Currently, durvalumab is not yet approved specifically for mesothelioma but is being studied in clinical trials to determine its safety and effectiveness. This medication works by helping the immune system better recognize and attack cancer cells, targeting specific proteins on the surface of mesothelioma cells that can suppress immune response.
Durvalumab functions as an immune checkpoint inhibitor, focusing on two proteins called PD-1 and PD-L1. These proteins, when linked, can trick the immune system into ignoring cancer cells, allowing the disease to spread more rapidly. The drug acts as a blockade that separates these proteins, enabling immune cells—particularly T-cells—to identify mesothelioma cells as dangerous and mount an attack. This mechanism aims to slow or halt cancer growth, especially when combined with other treatments like chemotherapy.
While durvalumab is administered intravenously, current protocols for lung cancer, which is related to mesothelioma in terms of location and type, involve treatments every three or four weeks. Patients interested in this therapy for mesothelioma should reach out to clinical trial programs, as it is not yet part of standard care. Clinical trial participation can offer access to the drug, often alongside other therapies, under carefully monitored conditions. Patients work with medical advocates and trial coordinators to find options suitable for their specific diagnosis and circumstances.
Studies so far suggest that durvalumab has the potential to improve survival times and response rates in mesothelioma patients. For example, recent trials have shown median survival periods of approximately 16 to 20 months, with some patients experiencing longer-term benefits. Ongoing studies continue to evaluate how best to incorporate durvalumab into treatment plans, potentially leading to future approval for mesothelioma if results remain positive. As with any immunotherapy, patients should be aware of possible side effects such as fatigue, fever, or shortness of breath, and discuss these thoroughly with their healthcare team. The goal is to provide patients and their families with options to manage this challenging disease with care, hope, and the most current scientific insights available.