Durvalumab extends survival in small cell lung cancer but raises cost concerns

Durvalumab extends survival in small cell lung cancer but raises cost concerns

A new study suggests that the immune checkpoint inhibitor durvalumab may offer new treatment options for patients with small cell lung cancer (SCLC). However, the costs raise questions about sustainability, prevention and access. The results were published in the December 19, 2025 issueJCO Global Oncology,are accompanied by an editorial titled “Durvalumab in limited-stage small cell lung cancer: Clinical triumph and path to sustainable value.”

SCLC is one of the most aggressive forms of lung cancer, accounting for approximately 15% of cases. Known for its rapid progression and poor prognosis, it has long been treated with a standard regimen of chemotherapy and radiation - a formula that has changed little in recent decades. The five-year survival rate is around 25 to 30%, leaving patients and families with limited hope.

Now immunotherapy is rewriting the narrative. Durvalumab has emerged as a promising addition to the treatment landscape for limited-stage disease. Supported by the ADRIATIC study, this therapy offers something patients have desperately needed: more time.

Durvalumab represents a turning point in the maintenance treatment of SCLC. We are experiencing survival gains that were unthinkable just a few years ago.”

Chinmay Jani, MD, lead author of the study and chief scientist of hematology and oncology at the Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine

In the ADRIATIC study, durvalumab was evaluated as maintenance therapy after chemoradiotherapy. The results were impressive: overall survival increased to 66.1 months, compared to 57.8 months with standard care. Progression-free survival also improved to 40.2 months compared to 31.8 months.

But hope comes at a high price. The study found that durvalumab therapy costs $163,722, compared to $25,816 for standard care. The incremental cost-effectiveness ratio (ICER) reached $383,069 per quality-adjusted life year (QALY), well above the US willingness-to-pay threshold of $150,000/QALY.

“Cost efficiency is not just a key figure – it shapes the approach in practice,” said Dr. Gilberto Lopes, Head of Medical Oncology and Deputy Director of Global Oncology at Sylvester. “We need strategies that make innovation sustainable.”

Interestingly, the analysis found that durvalumab nearly met cost-effectiveness standards in patients with extrathoracic progression, with an ICER of $151,137/QALY. This suggests that precision medicine – therapy tailored to specific patient profiles – could optimize both outcomes and affordability.

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