A recent study has found that the immune checkpoint inhibitor durvalumab can extend survival for patients with small cell lung cancer (SCLC), but its high cost is raising concerns about access and sustainability. The findings were published in the December 19, 2025, issue of JCO Global Oncology, along with an editorial discussing the clinical and economic implications.
SCLC is a particularly aggressive type of lung cancer, making up about 15% of all lung cancer cases. It progresses quickly and has a poor prognosis. Traditional treatment, which combines chemotherapy and radiation, has not changed significantly in decades, and five-year survival rates remain low at around 25% to 30%.
The introduction of immunotherapy is changing the outlook for some patients. Durvalumab, supported by results from the ADRIATIC trial, is showing promise as an additional treatment for limited-stage SCLC.
"Durvalumab represents a turning point in maintenance therapy for SCLC," said Chinmay Jani, M.D., first author on the study and chief fellow in hematology and oncology at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. "We're seeing survival gains that were unimaginable just a few years ago."
In the ADRIATIC trial, durvalumab was used as maintenance therapy after chemoradiation. Patients receiving durvalumab had an overall survival rate of 66.1 months compared to 57.8 months with standard care. Progression-free survival also improved to 40.2 months versus 31.8 months.
However, these benefits come with significant costs. The study reports that durvalumab therapy costs $163,722 per patient compared to $25,816 for standard care. The incremental cost-effectiveness ratio (ICER) was calculated at $383,069 per quality-adjusted life year (QALY), which exceeds the commonly accepted U.S. threshold of $150,000/QALY.
"Cost-effectiveness isn't just a metric—it shapes real-world access," said Gilberto Lopes, M.D., chief of the Division of Medical Oncology and associate director for global oncology at Sylvester. "We need strategies that make innovation sustainable."
The analysis also indicated that among patients whose disease had spread outside the chest (extrathoracic progression), durvalumab nearly reached acceptable cost-effectiveness standards with an ICER of $151,137/QALY. This finding suggests that using precision medicine approaches—targeting treatments based on specific patient characteristics—could help balance improved outcomes with affordability.
