Expert Perspectives on Patient Selection and Treatment Contraindications

The panel provides detailed insights into specific patient populations that may not be suitable candidates for durvalumab consolidation therapy in limited-stage small cell lung cancer (SCLC). Ticiana Leal, MD, emphasizes that the ADRIATIC trial demonstrated significant survival benefits with hazard ratios of 0.73 for overall survival and 0.76 for progression-free survival, making patient selection decisions particularly important. Beyond autoimmune diseases, the experts identify paraneoplastic neurologic syndromes requiring immunosuppression and solid organ transplant recipients as additional populations requiring careful consideration.

Treatment completion challenges emerge as a significant practical consideration, with only approximately one-third of patients in the ADRIATIC trial completing the full 2-year durvalumab course. The primary reasons for discontinuation include disease progression rather than toxicity, though 10% to 15% of patients do discontinue due to adverse events. The experts stress the importance of comprehensive patient and caregiver education about the prolonged treatment commitment, including logistical considerations such as transportation and social support systems, particularly for elderly patients or those with geographical barriers to treatment access.

The discussion emphasizes that while 2 years represents the studied duration, the clinical benefit likely occurs early in treatment, making initial months particularly crucial. The panel advocates for optimizing supportive care and addressing potential barriers upfront to maximize treatment completion rates. They also highlight the importance of individualized decision-making, considering patient-specific factors while maintaining the understanding that durvalumab consolidation represents a new standard of care with demonstrated survival benefits that justify the treatment commitment required.