Durvalumab extends survival in small cell lung cancer while raising critical cost-effectiveness concerns.

Researchers at the Sylvester Comprehensive Cancer Center (FL, USA) have unveiled findings from the ADRIATIC clinical trial, showing that durvalumab, an immune checkpoint inhibitor, significantly improves survival for patients with limited-stage small cell lung cancer (LS-SCLC). Led by Chinmay Jani and published in JCO Global Oncology, the study underscores durvalumab’s potential to advance LS-SCLC treatment. However, the high cost of the therapy raises concerns about accessibility and sustainability.

Small cell lung cancer (SCLC) is an aggressive form of lung cancer, accounting for 15% of all cases. Despite decades of research, treatment options have remained largely unchanged, relying on chemotherapy and radiation as the standard of care, with 5-year survival rates as low as 25% to 30%. The ADRIATIC trial offers new hope, showing that immunotherapy could improve outcomes for this challenging disease.

The trial evaluated durvalumab as a maintenance therapy following chemoradiation, yielding remarkable results. Overall survival increased to 66.1 months compared to 57.8 months with standard care, while progression-free survival improved to 40.2 months versus 31.8 months. “Durvalumab represents a turning point in maintenance therapy for SCLC,” explained Jani, first author of the study. “We’re seeing survival gains that were unimaginable just a few years ago.”

However, durvalumab’s promise comes with a steep price. The therapy costs $163,722 compared to $25,816 for standard care, resulting in an incremental cost of $137,905. The study calculated an incremental cost-effectiveness ratio (ICER) of $383,069 per quality-adjusted life year (QALY), far exceeding the U.S. willingness-to-pay threshold of $150,000/QALY. This raises critical concerns about affordability and the financial burden on healthcare systems.

“Cost-effectiveness isn’t just a metric—it shapes real-world access,” commented Gilberto Lopes, chief of the Division of Medical Oncology and associate director for global oncology at Sylvester. “We need strategies that make innovation sustainable.” Notably, the study found that for patients with extrathoracic progression, durvalumab nearly met cost-effectiveness standards, with an ICER of $151,137/QALY. This finding underscores the potential of precision medicine approaches could simultaneously enhance clinical outcomes while balancing affordability.

Drug pricing and access to cancer medicines

Hear more from Gilberto Lopes in this exclusive interview, in which he discusses initiatives that the ATOM coalition are working on to improve access to cancer medicines.

An accompanying editorial, “Durvalumab in limited-stage small cell lung cancer: clinical triumph and toward sustainable value”, emphasizes the need for pricing reforms and innovative delivery models to ensure equitable access. While durvalumab offers significant clinical benefits, its high cost highlights the importance of aligning innovation with affordability. “Durvalumab increases up-front expenditures but may avert substantial downstream costs by delaying or preventing relapse,” the editorial notes. “Future evaluations should incorporate these downstream costs to provide a more complete estimate of long-term value.”

The editorial also explores strategies to enhance affordability, including molecular subtyping to identify patients most likely to benefit, adaptive dosing strategies, and global access initiatives such as tiered pricing and pooled procurement. These approaches could help bridge the gap between clinical innovation and real-world accessibility, particularly in resource-limited settings.

The ADRIATIC trial marks a milestone in SCLC care, offering new hope to patients and families. However, the findings highlight the urgent need for collaboration among policymakers, healthcare providers and pharmaceutical companies to address the economic challenges of immunotherapy. By doing so, durvalumab could transition from a clinical breakthrough to a sustainable and equitable standard of care.