Loren K. Mell, MD
Durvalumab, an immune checkpoint inhibitor, has shown activity in treating a wide range of cancers and has been proposed as a potentially safer and more effective option than cetuximab, according to Loren K. Mell, MD, Professor and Vice Chair of Clinical and Translational Research at University of California San Diego School of Medicine Department of Radiation Medicine and Applied Sciences, and Co-Leader of the UC San Diego Moores Cancer Center Head/Neck Disease Team.
However, in a recent clinical trial, Dr. Mell and colleagues from more than 20 other institutions compared the effectiveness of durvalumab and cetuximab—in combination with radiation therapy—in 186 patients with advanced squamous cell carcinoma of the head or neck who were ineligible for cisplatin. They reported that contrary to expectations, cetuximab performed better than durvalumab, with a similar rate of adverse events. As a result, the researchers discontinued the study early and published their results in The Lancet Oncology.1
“We found that the probability of being alive and free of disease at 2 years was approximately 64% for cetuximab vs 51% for durvalumab, indicating no evidence of a benefit of durvalumab over cetuximab,” said Dr. Mell. “We had a lot of reasons to be optimistic about durvalumab, but it turned out to be potentially worse than the standard.” Dr. Mell said there is some evidence that durvalumab may still have a place in treating a very specific subset of patients with highly immunoreactive tumors, but more research is needed.
The study demonstrated a higher success rate than any previous study of cetuximab in this patient population. Dr. Mell said the drug could become the new standard of care for these patients. The study also revealed that cetuximab showed similar efficacy whether or not a patient’s cancer was associated with human papillomavirus.
DISCLOSURE: For full disclosures of the study authors, visit thelancet.com.
REFERENCE
1. Mell LK, et al: Radiotherapy with cetuximab or durvalumab for locoregionally advanced head and neck cancer in patients with a contraindication to cisplatin (NRG-HN004). Lancet Oncol. November 14, 2024 (early release online).
