Navigating Disease Progression During and After Durvalumab: Expert Insights

The discussion addressed how patients are monitored during consolidation durvalumab following chemoradiation in limited-stage small cell lung cancer (LS-SCLC). While monthly infusions are standard, many patients require closer follow-up, particularly in the early months, due to lingering adverse effects such as fatigue and esophagitis. A key concern is pneumonitis, which may be more common in clinical practice than reported in trials, especially among patients with underlying lung disease. Early collaboration with pulmonology was emphasized as essential for evaluating new respiratory symptoms, differentiating between immune-related and radiation-induced toxicity, and guiding decisions about holding or restarting therapy.

In the setting of relapse, the approach has shifted significantly. While platinum rechallenge was once a standard for patients with platinum-sensitive relapse (commonly defined as progression beyond 3 to 6 months), it is now used more selectively. Factors such as prior toxicity, cumulative burden, and patient preference play a major role. The traditional benefit of platinum rechallenge—about half the efficacy seen in the first-line setting—is weighed against the availability of newer, less toxic options that show meaningful activity and better tolerability.

Agents such as lurbinectedin and tarlatamab (a bispecific T-cell engager targeting DLL3) are increasingly favored in the second-line setting. These therapies offer durable responses for some patients, including those with platinum-resistant disease. In particular, emerging data suggest higher disease control rates with these agents, especially in patients relapsing beyond 90 days from prior therapy. There was strong consensus that platinum rechallenge is no longer the default and that decisions must be tailored based on relapse timing, disease burden, patient fitness, and evolving therapeutic options.