According to a report presented at the 2025 ESMO Congress, mesothelioma patients treated with first-line Imfinzi (durvalumab) plus chemotherapy achieved a median overall survival of 21 months compared to 18 months with chemotherapy alone in the phase 3 DREAM3R study. However, slow patient enrollment and shifting standards of treatment complicated the study’s protocol, leading to inconclusive results and its early termination.
Despite Demonstrated Improvements, Complications Led to Trial Being Canceled
The study aimed to evaluate the safety and effectiveness of the chemotherapy and Imfinizi combination in mesothelioma, and the therapy produced consistent improvements: median progression-free survival was 8 months with the immunotherapy/chemotherapy combination compared to 7 months with chemotherapy alone, and the objective response rate of 58 percent compared to chemotherapy’s 35 percent was i keeping with previous findings.
Despite these positive indications, the study’s results were complicated by the dramatic shift in mesothelioma care protocols that followed the CheckMate 743 study, which demonstrated the improvements offered by nivolumab (Opdivo) combined with ipilimumab (Yervoy). This breakthrough coincided with the onset of the DREAM3R trial and led to modifications in the trial’s design. Additionally, patient enrollment slowed considerably as a result of the global pandemic.
Mesothelioma Safety Profile Remained Consistent with Known Treatment Effects
Though these complications led to early termination of the mesothelioma trial, Dr. Anna Nowak, deputy vice chancellor at the University of Western Australia, noted that treatment development may benefit from the DREAM3R findings, which showed that Imfinzi plus chemotherapy provided a high tumor response and disease control. Dr. Nowak specifically suggested the potential for future testing in the neoadjuvant setting of treatment given before surgery to shrink tumors, and emphasized the potential value of further biomarker analyses.
Mesothelioma patients in both treatment arms experienced side effects consistent with the known profiles of these therapies, with fatigue, nausea, and anemia representing the most commonly reported adverse events in both the Imfinzi plus chemotherapy group and the chemotherapy-only group. In addition to presenting the limited results of the study, Dr. Nowak highlighted what was learned from the negative outcome of the study: the importance of initiating randomized phase 3 trials promptly after positive phase 2 results to maximize enrollment and generate reliable evidence.
Ongoing studies of mesothelioma treatments are advancing patients’ quality of life. For information on accessing care and other valuable resources, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.