Durvalumab Plus Platinum-Based Chemotherapy for Treatment-Naive Patients With Extensive-Stage Small Cell Lung Cancer

According to exploratory subgroup analysis results from the phase 3 CASPIAN trial, durvalumab plus etoposide and carboplatin or cisplatin demonstrated efficacy and safety regardless of age or sex among treatment-naive patients with extensive-stage small cell lung cancer (ES-SCLC). 

“First-line durvalumab plus etoposide combined with either carboplatin or cisplatin significantly improved overall survival (OS) versus [etoposide plus carboplatin or cisplatin] alone,” stated Niels Reinmuth, MD, PhD, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany, and coauthors. Here, “We report exploratory subgroup analyses from CASPIAN.” 

In this study, 537 patients were randomized to receive etoposide plus carboplatin or cisplatin either alone (n = 269) or in combination with durvalumab (n = 268). Patients were broken into subgroups based on age (< 70 years, n = 433; ≥ 70 years, n = 104), sex (female, n = 163; male, n = 374), and chosen platinum-based regimen (cisplatin, n = 135; carboplatin, n = 402). The primary end point was OS. A key secondary end point was safety. 

At analysis, the hazard ratio (HR) for OS was 0.71 in patients < 70 years and 0.74 in patients ≥ 70 years. The HR for OS was 0.60 in female patients and 0.76 in male patients. The HR for OS was 0.65 in cisplatin patients and 0.74 in carboplatin patients. Rates of grade 3/4 adverse events were similar across all subgroups. Serious adverse events were more frequently reported in patients ≥ 70 years, and immune-mediated adverse events were more frequently reported in female patients. 

“These findings support the use of durvalumab plus EP as first-line standard of care for ES-SCLC,” concluded Dr Reinmuth et al. “Additional trials focused on elderly populations would be informative.” 

Source: 

Reinmuth N, Goldman JW, Chen Y, et al. Durvalumab plus platinum-etoposide in extensive-stage small-cell lung cancer: Outcomes in age, sex, and platinum subgroups from the phase 3 CASPIAN study. Clin Lung Cancer. Published online: August 2, 2025. doi: 10.1016/j.cllc.2025.08.001