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.

written

Written by Karen Ritter, RN BSN

fact

Fact Checked

popout

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:

1

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.

2

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.

3

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:

1

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.

2

Look up the side effects of durvalumab. Some patients may respond better to a different immunotherapy for mesothelioma, such as Opdivo and Yervoy.

3

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% 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 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

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:

1

Durvalumab and chemotherapy every three weeks for 4‑6 cycles

2

Maintenance durvalumab every four weeks once chemotherapy ends

If durvalumab again improves survival, it may lead to an FDA approval for mesothelioma.

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

Karen image

About the Writer, Karen Ritter, RN BSN

Karen Ritter is a registered nurse and patient advocate for Mesothelioma Guide. She leads patients and families through their mesothelioma diagnosis, explaining treatments and support options. Karen joined Mesothelioma Guide in 2021.