A Real-world Study of Durvalumab for Lung Cancer in China

Inclusion Criteria:

1. Patient capable of proper therapeutic compliance, and accessible to correct follow-up.
2. Written Informed Consent (IC) for trial treatment must be signed and dated by the patient and the investigator prior to any trial-related evaluation and/or intervention.
3. Age ≥ 18 years at time of study entry or adult according to each country regulations for age of majority.
4. Patients must have histologically or cytologically documented diagnosis of NSCLC with a locally advanced, or locally recurrent, unresectable (stage III) disease (according to American Joint Committee on Cancer \[AJCC\] lung cancer edition 8). Histologically or cytologically documented extensive disease (American Joint Committee on Cancer Stage (8th edition) IV SCLC. Brain MRI or high-quality brain CT with intravenous contrast at the time of staging mandatory is strongly recommended.
5. Patients who received definitive concurrent chemoradiation therapy and have not progressed were enrolled in the Cohort 1. Patients who received chemotherapy, radiotherapy or sequential chemotherapy were enrolled in the Cohort 2.
6. Tumour sample requirements: Provision of an unstained tumor samples in a quantity sufficient to allow for analysis (≤3 months newly collected sample is preferred, ≤6 months archival sample is also accepted.)
7. No prior exposure to immune-mediated therapy including, but not limited to, other.
8. anti-CTLA-4, anti-PD-1, anti-PD-L1, and anti-programmed cell death ligand 2.
9. (anti-PD-L2) antibodies, excluding therapeutic anticancer vaccines.

Exclusion Criteria:

1. Patients should not enter the study if any of the following exclusion criteria are fulfilled:
2. History of allogenic organ transplantation.
3. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[eg, colitis or Crohn's disease\], diverticulitis with the exception of diverticulosis, systemic lupus erythematosus, sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, and uveitis, etc\]). The following are exceptions to this criterion:

   * Patients with vitiligo or alopecia
   * Patients with hypothyroidism (eg, following Hashimoto syndrome) and stable
   * on hormone replacement
   * Any chronic skin condition that does not require systemic therapy
   * Patients without active disease in the last 5 years may be included but only after
   * consultation with the Study Physician
   * Patients with celiac disease controlled by diet alone
4. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, interstitial lung disease, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent.
5. History of another primary malignancy except for

   * Malignancy treated with curative intent and with no known active disease ≥5 years before the first dose of IP and of low potential risk for recurrence
   * Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
   * Adequately treated carcinoma in situ without evidence of disease
6. History of active primary immunodeficiency.
7. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice), hepatitis B (known positive HBV surface antigen \[HbsAg\] result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HbsAg) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
8. Mixed small cell and non-small cell lung cancer histology
9. Any unresolved toxicity CTCAE ≥Grade 2 from the prior chemoradiation therapy. Patients with irreversible toxicity that is not reasonably expected to be exacerbated by study drug may be included (eg, hearing loss) after consultation with the AstraZeneca/MedImmune medical monitor.
10. Patients with ≥Grade 2 pneumonitis from prior chemoradiation therapy
11. Known allergy or hypersensitivity to durvalumab or any of their excipients
12. Any concurrent chemotherapy, IP, biologic, or hormonal therapy for cancer treatment
13. Receipt of live, attenuated vaccine within 30 days prior to the first dose of IP. Note: Patients, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP.
14. Recent major surgery within 4 weeks prior to entry into the study (excluding the placement of vascular access) that would prevent administration of study drug
15. Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab or tremelimumab. The following are exceptions to this criterion:

    * Intranasal, inhaled, topical steroids or local steroid injections (eg, intra articular injection).
    * Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent.
    * Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication). Premedication with steroids for chemotherapy is acceptable. Systemic steroid administration required to manage toxicities arising from radiation therapy delivered as part of the chemoradiation therapy for locally advanced NSCLC is allowed
16. Participation in another clinical study with an IP during the last 4 weeks
17. Previous enrolment or randomisation in the present study
18. Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study
19. Prior randomization or treatment in a previous durvalumab and/or tremelimumab clinical study regardless of treatment arm assignment.
20. Female patients who are pregnant or breastfeeding or male or female patients of reproductive potential who are not willing to employ effective birth control from Screening to 90 days after the last dose of durvalumab monotherapy
21. According to the investigator, if the subject is unable to comply with procedures required by the clinical investigation, the subject is not allowed to participate in this study.