Written By: Devin Golden
Durvalumab (Imfinzi) for Mesothelioma
Durvalumab is an immunotherapy treatment for malignant mesothelioma. It often goes by the brand name Imfinzi. Durvalumab is an immune checkpoint inhibitor. The drug helps the immune system fight cancer.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
JUMP TO A TOPIC
Important Facts About Durvalumab for Mesothelioma
- Durvalumab is not approved yet for malignant mesothelioma. It’s currently in the clinical trial phase. It’s mostly tested for pleural mesothelioma.
- Durvalumab can pair with other therapies, such as chemotherapy. It improves survival for patients compared to using chemotherapy alone.
- The immunotherapy drug focuses on keeping the PD-1 and PD-L1 protein receptors separate. These receptors linking can suppress the immune system.
- The DREAM study is the latest one involving durvalumab. The phase 2 trial was successful enough to encourage planning for a phase 3 study. The new study is called DREAM3R.
What Is Durvalumab?
Durvalumab is an emerging cancer treatment. It’s an immunotherapy drug tasked with helping the immune system identify cancer cells more easily. AstraZeneca manufactures durvalumab. The company sells the drug under the name Imfinzi.
Durvalumab treats cancer by focusing on the PD-L1 protein receptor. This protein is on the surface of many mesothelioma cells. The drug targets this receptor.
The U.S. Food and Drug Administration (FDA) approved durvalumab for both types of lung cancer (non-small cell and small cell). These cancers are often compared due to their location: Lung cancer develops in the lungs and pleural mesothelioma develops in the lining of the lungs.
How Does Durvalumab Work for Mesothelioma?
Mesothelioma is a fast-spreading cancer. It moves quickly due to the ability to avoid the body’s natural immune system defenses. Durvalumab is a therapeutic counter to slow or stop the growth of mesothelioma.
The immunotherapy focuses on two protein receptors. One, PD-1, is on the surface of immune system T-cells. The other protein receptor, PD-L1, is on the surface of mesothelioma cells. Durvalumab splits these protein receptors.
Here are the steps of how durvalumab works as a mesothelioma treatment:
- Repressed immune system — When the PD-1 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.
- Inserting a blockade — Durvalumab enters the diseased area, either the chest or abdominal cavity. The drug acts as a wall, or blockade, between the two protein receptors.
- Improved immune response — The immune system’s T-cells can identify mesothelioma cells as dangerous 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 hasn’t approved durvalumab for mesothelioma, access is restricted to clinical trials. Here’s a guide on how to receive durvalumab before the FDA signs off on the therapy:
- Contact a mesothelioma patient advocate. This step makes the entire process much easier. They can help you find a list of ongoing clinical trials around the country.
- Look up the side effects of durvalumab. Some patients may respond better to a different immunotherapy for mesothelioma, such as Opdivo and Yervoy.
- Sign up for a clinical trial. With the help of an experienced patient advocate, you can find a recruiting trial using durvalumab. If it’s not nearby, your patient advocate can help overcome any financial hurdles regarding travel, lodging and time off from work.
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 is the latest durvalumab study for mesothelioma. Researchers tested durvalumab with chemotherapy and compared the results to receiving only chemotherapy.
The FDA approved chemotherapy (pemetrexed and cisplatin) for mesothelioma. Most studies seeking approval will compare their therapy to chemotherapy.
In the DREAM clinical trial, durvalumab with chemotherapy had a median survival of 20.4 months. This outperforms chemotherapy by 6-8 months.
Other stats from the study were:
- 56.4% partial response, meaning the cancer retreated/shrank
- 40% stable disease, meaning the cancer neither grew nor shrank
- 70.4% 1-year survival rate
- 44.2% 2-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 tolerable
Another phase 2 study used durvalumab with tremelimumab. The latter is another checkpoint inhibitor. Tremelimumab focuses on splitting up the CTLA-4 and B7 protein receptors.
The median survival was 16.5 months for 40 patients:
- 20% survived for three years
- 15% survived for four years
Baylor College of Medicine, affiliated with Baylor St. Luke’s Medical Center, hosted a phase 1 clinical trial. Eight patients received durvalumab and tremelimumab. Five of the eight patients completing immunotherapy treatment were still alive at the check-up.
DREAM3R Study for Durvalumab and Mesothelioma
DREAM3R, a phase 3 durvalumab study, is now accepting patients. It has room for up to 400 patients.
Two-thirds of participants will receive durvalumab and chemotherapy. One-third will receive chemotherapy alone. The cycles will follow the FDA’s recommendations for non-small-cell lung cancer:
- Durvalumab and chemotherapy every three weeks for 4-6 cycles
- Maintenance durvalumab every four weeks once chemotherapy ends
If durvalumab again improves survival, it may lead to an FDA approval for mesothelioma.
Durvalumab for Lung Cancer
The FDA approved durvalumab and tremelimumab as a combination for non-small-cell lung cancer patients with metastatic disease. The approval is for people with stage 4 non-small-cell lung cancer after the immunotherapy combination outperformed chemotherapy:
- 33% 2-year survival rate for durvalumab and tremelimumab
- 22% 2-year survival rate for chemotherapy
In the PACIFIC clinical trial, durvalumab was used after chemotherapy and radiation therapy for lung cancer. It helped with survival for these patients, who had locally advanced non-small-cell lung cancer (meaning stage 2 or stage 3 cancer).
A study in Brazil tested durvalumab on 177 patients with stage 3 NSCLC. The median overall survival was 34.9 months, which is nearly 3 years. This is much improved from the usual survival expectancy for stage 3 NSCLC.
A study in Croatia of 42 lung cancer patients had a median survival of more than three years thanks to durvalumab. Two-thirds of the patients were alive after 32 months, which was the study’s data cutoff. The progression-free survival was two years.
Side Effects of Durvalumab
Durvalumab can cause side effects for patients. The common ones are:
- Loss of appetite
- Fatigue
- Fever
- Nausea
- Shortness of breath
There are less common and more severe side effects, such as: pain while urinating, bloating or swelling of the face or extremities (hands, feet, legs and arms), rashes, bladder pain and slowed heartbeat.
These are just a few durvalumab side effects. We recommend contacting your doctor if you experience any of these. We also recommend reviewing potential side effects with your doctor before starting durvalumab for mesothelioma.
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: 04/20/2021.
- Durvalumab added to standard chemotherapy improved overall survival in mesothelioma. American Association for the Advancement of Science. Retrieved from:
https://eurekalert.org/pub_releases/2020-05/ecrg-dat052020.php. Accessed: 05/21/2020. - 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: 03/19/2021.
- DuRvalumab With chEmotherapy as First Line treatment in Advanced Pleural Mesothelioma (DREAM3R). Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04334759. Accessed: 03/19/2021.
- Durvalumab (Intravenous Route). Mayo Clinic. Retrieved from: https://www.mayoclinic.org/drugs-supplements/durvalumab-intravenous-route/side-effects/drg-20406270. Accessed: 07/30/2021.
- FDA approves durvalumab for extensive-stage small cell lung cancer. U.S. Food and Drug Administration. Retrieved from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-durvalumab-extensive-stage-small-cell-lung-cancer. Accessed: 07/30/2021.
- MEDI4736 Or MEDI4736 + Tremelimumab In Surgically Resectable Malignant Pleural Mesothelioma. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/study/NCT02592551. Accessed: 01/20/2022.
- Real-World Evidence Confirms Survival Benefit of Durvalumab in Locally Advanced Non–Small Cell Lung Cancer. American Society of Clinical Oncology. Retrieved from: https://ascopost.com/issues/september-10-2022/real-world-evidence-confirms-survival-benefit-of-durvalumab-in-locally-advanced-non-small-cell-lung-cancer/. Accessed: 08/20/2022.
- Imfinzi and tremelimumab with chemotherapy demonstrated sustained survival benefit in metastatic non-small cell lung cancer, nearly doubling the number of patients alive after three years vs. chemotherapy. AstraZeneca. Retrieved from: https://www.astrazeneca.com/media-centre/press-releases/2022/imfinzi-and-tremelimumab-with-chemotherapy-demonstrated-sustained-survival-benefit-in-metastatic-non-small-cell-lung-cancer.html#!. Accessed: 09/12/2022.
