NEJM Research March 2026

Imfinzi (durvalumab) after Chemoradiotherapy in Limited-Stage Small Cell Lung Cancer: What Did the ADRIATIC Trial Show

The New England Journal of Medicine has published the results of the ADRIATIC trial in patients with limited-stage small cell lung cancer who had no progression after concurrent chemoradiotherapy. The trial evaluated adjuvant Imfinzi (durvalumab) versus placebo. The durvalumab regimen improved both overall survival and progression-free survival.

In brief: what happened

264 patients were randomized to the Imfinzi group and 266 to the placebo group.

Median overall survival was 55.9 months versus 33.4 months.
Median progression-free survival was 16.6 months versus 9.2 months.
The rate of grade 3–4 adverse events was almost identical: 24.4% versus 24.2%.

Key numbers from the trial

Imfinzi (durvalumab) reduced the risk of death by 27% (HR 0.73; p=0.01). The risk of progression or death was reduced by 24% (HR 0.76; p=0.02). The rate of grade 3–4 pneumonitis or radiation pneumonitis was 3.1% versus 2.6%.

Why this matters in practice

For limited-stage small cell lung cancer, the standard for a long time was concurrent chemoradiotherapy alone followed by observation. ADRIATIC changes this approach. After successful completion of chemoradiotherapy, some patients now have an additional active stage of treatment.

Limitations / what does not change yet

These results apply only to limited-stage small cell lung cancer after successful chemoradiotherapy. They do not apply to extensive-stage disease and do not mean a change in approach for patients whose disease progressed during chemoradiotherapy.

Commentary by Evgeny Ledin

This news is relevant for patients with limited-stage small cell lung cancer who have completed concurrent chemoradiotherapy and achieved disease control. For this group, ADRIATIC changes the approach after chemoradiotherapy. Instead of simple observation, there is now a proven active option.

From the standpoint of therapy choice, this means that after chemoradiotherapy it is now necessary to discuss not only the results of the follow-up examination, but also the question of subsequent treatment with Imfinzi (durvalumab).

Conclusion: for a suitable patient after chemoradiotherapy in limited-stage SCLC, Imfinzi (durvalumab) should already be discussed as a real, modern option. But its place is determined not by the name of the trial, but by the specific clinical situation.

When a second opinion is especially useful

chemoradiotherapy is already completed and the further plan is unclear;
you are being offered observation only;
there are doubts about whether the stage was indeed limited;
the risk of pneumonitis and overall tolerability need to be assessed.

What to prepare for the consultation

histopathology report;
protocols of the chemoradiotherapy that was given;
CT or PET-CT after treatment;
a description of lung function, if available;
list of comorbidities and current medications;
data on the tolerability of chemoradiotherapy.

Source: The New England Journal of Medicine: Durvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer

Frequently Asked Questions

Is this regimen suitable for patients with extensive-stage SCLC?

No. ADRIATIC studied only limited-stage disease after successful chemoradiotherapy.

Did radiotherapy need to be completed before starting Imfinzi?

Yes. Durvalumab was given after concurrent chemoradiotherapy in the absence of progression.

Was toxicity significantly higher?

No. The rate of severe adverse events was similar in the durvalumab and placebo groups.