CASPIAN

一行要約

未治療 ES-SCLC への Durvalumab ± Tremelimumab + platinum-etoposide vs 化療単独の phase III (3-arm)。Durvalumab+chemo で OS HR 0.73 (mOS 13.0 vs 10.3 mo) → SCLC 1L durvalumab+chemo を IMpower133 と並び標準化。Tremelimumab 追加 arm は陰性。

試験デザイン

• 対象: 未治療 ES-SCLC、N=805 (3-arm)
• Arm 1: Durvalumab + Cisplatin or Carboplatin + Etoposide × 4 → Durvalumab maintenance
• Arm 2: Durvalumab + Tremelimumab + 化療 × 4 → Durvalumab maintenance
• Arm 3 (control): Cisplatin or Carboplatin + Etoposide × 6
• 特徴: IMpower133 と異なり Cisplatin も許容、化療 6 cycles 対照

主要結果

• OS arm 1 vs control: HR 0.73 (95% CI 0.59–0.91, p=0.0047), median 13.0 vs 10.3 mo
• OS arm 2 vs control: HR 0.82, median 10.4 vs 10.3 mo (陰性、Tremelimumab 追加 benefit なし)
• 3-yr OS update: 17.6% vs 5.8% (durvalumab arm long-term plateau)
• AE: Grade 3-4 62% vs 62%、毒性 IO 追加で大きく増えず

臨床的意義

• IMpower133 と並び SCLC 1L IO+chemo 標準化
• Durvalumab maintenance での持続効果 (3-yr 17.6% は IMpower133 と同等)
• Tremelimumab 追加が陰性 → SCLC での dual IO+chemo は probit benefit ない (CTLA-4 SCLC で一般的に benefit limited)
• Cisplatin / Carboplatin 両方許容で柔軟性

Open Questions

• CASPIAN vs IMpower133 selection: 直接比較なし、cisplatin/carboplatin 選好で判断
• SCLC dual IO の意義: Tremelimumab 追加陰性、SCLC で CTLA-4 が効きにくい理由
• Durvalumab consolidation 期間: maintenance 制限なし、長期効果 vs 毒性
• Tarlatamab maintenance (DeLLphi-305) への展開: SCLC IO 標準の更新

重要論文 Top 10

1. ★★★★★ Paz-Ares et al. Lancet 2019 — CASPIAN primary publication
2. ★★★★★ Paz-Ares et al. Lancet 2019 — 2-yr update
3. JTO-2022-Goldman-Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer CASPIAN updated — 3-yr update
4. ★★★★ Horn et al. NEnglJMed 2018 — IMpower133 — parallel SCLC standard
5. ★★★★ Baas et al. Lancet 2021 — CheckMate-743 — SCLC とは異なる dual IO 成功例

関連エンティティ

• 薬剤クラス: PD-L1-inhibitor (Durvalumab), CTLA-4-inhibitor (Tremelimumab), Platinum-chemotherapy
• 関連試験: IMpower133 / CheckMate-227 (dual IO NSCLC) / DeLLphi-305
• ドメイン: lung-cancer-treatment

関連論文

直近 30 件のみ表示中 (関連 64 件)。 全件は MOC ページ または Obsidian (source Markdown) から辿れます。

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• Lu et al. JClinOncol 2026 — Multicenter cohort study of original or substitute systemic therapy with or without brain radiotherapy for

Basic-Liquid-biopsy

• Haq et al. iScience 2022 — Cell-free DNA methylation-defined prognostic subgroups in small-cell lung cancer identified by leukocyte methylation …

Clinical-NEC

• Sen et al. LancetOncol 2025 — Pulmonary neuroendocrine neoplasms the molecular landscape, therapeutic challenges, and diagnosis and management
• Heijboer et al. LungCancer 2025 — Treatment outcomes in patients with stage IV large cell neuroendocrine carcinoma a nationwide registry study

Clinical-NSCLC-Driver negative

• Li et al. FrontImmunol 2026 — The application and challenges of immune checkpoint inhibitors in lung cancer therapy

Clinical-NSCLC-EGFR

• Okamoto et al. LungCancer 2026 — Durvalumab plus etoposide-platinum in patients with epidermal growth factor receptor (EGFR)-mutated advanced NSCLC and

Clinical-SCLC

• Dingemans et al. AnnOncol 2021 — Small-cell lung cancer ESMO clinical practice guidelines for diagnosis, treatment and follow-up
• Spigel et al. AnnOncol 2021 — Second-line nivolumab in relapsed small-cell lung cancer CheckMate 331
• Asao et al. BMCCancer 2022 — A phase II study of carboplatin and etoposide plus durvalumab for previously untreated extensive-stage small-cell lung
• Agarwal et al. Cancer 2023 — Chemoimmunotherapy in patients with extensive-stage small cell lung cancer and a poor performance status
• Sethakorn et al. Cancer 2026 — The future promise of antibody-drug conjugates in extensive-stage small cell lung cancer
• Choi et al. CancerResTreat 2024 — The real-world outcome of first line atezolizumab in extensive-stage small cell lung cancer A multicenter prospective
• Guan et al. CritRevOncolHematol 2026 — Overcoming immunotherapy resistance in extensive-stage small cell lung cancer insights into mechanisms and therapeutic
• Dai et al. CurrTreatOptionsOncol 2026 — Addressing unmet needs in the management of small cell lung cancer treatment of brain metastases, quality of life, and
• Falchero et al. EurJCancer 2024 — Real-life nationwide characteristics and outcomes of small cell lung cancer over the last 20 years impact of
• Zhang et al. FrontImmunol 2026 — First-line serplulimab plus chemotherapy versus chemotherapy alone in small-cell lung cancer patients with brain
• Rittberg et al. FrontOncol 2022 — Real-world eligibility for platinum doublet plus immune checkpoint inhibitors in extensive-stage small-cell lung cancer
• Daniel et al. IntJCancer 2021 — Trilaciclib prior to chemotherapy and atezolizumab in patients with newly diagnosed extensive-stage small cell lung
• Liu et al. JAMAOncol 2026 — First-line serplulimab in extensive-stage small cell lung cancer secondary analysis of the ASTRUM-005 phase 3
• Liu et al. JClinOncol 2021 — Updated overall survival and PD-L1 subgroup analysis of patients with extensive-stage small-cell lung cancer treated
• Khurshid et al. JClinOncol 2023 — Systemic therapy for small-cell lung cancer ASCO-ontario health (cancer care ontario) guideline
• Elegbede et al. JTOClinResRep 2021 — A real-world evaluation of atezolizumab plus platinum-etoposide chemotherapy in patients with extensive-stage SCLC in
• Paulson et al. LancetOncol 2025 — Safety and activity of tarlatamab in combination with a PD-L1 inhibitor as first-line maintenance therapy after
• Asao et al. LancetRespirMed 2025 — Durvalumab, carboplatin, and etoposide in patients who are treatment-naive with extensive-stage small-cell lung cancer
• Reguart et al. LancetRespirMed 2025 — Rethinking immunotherapy in patients with SCLC with poor performance status
• Sagie et al. LungCancer 2022 — Real-world evidence for immunotherapy in the first line setting in small cell lung cancer
• Cheng et al. NEnglJMed 2024 — Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer
• Byers et al. NatMed 2026 — SEZ6-targeting antibody-drug conjugate ABBV-706 in advanced small cell lung cancer and solid tumors a phase 1 trial
• Mamesaya et al. ThoracCancer 2023 — Efficacy and safety of carboplatin and etoposide in older extensive-stage small-cell lung cancer patients with a poor

Clinical-irAE

• Govindan et al. JImmunotherCancer 2022 — Society for immunotherapy of cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung