Sunil Verma, MD, senior vice president and global head of oncology, medical, at AstraZeneca, discusses the addition of durvalumab to a chemotherapy regimen of gemcitabine and cisplatin for biliary duct cancer.
Sunil Verma, MD, senior vice president and global head of oncology, medical, at AstraZeneca, discusses the addition of durvalumab to a chemotherapy regimen of gemcitabine and cisplatin for biliary duct cancer, as investigated in the TOPAZ-1 trial.
TOPAZ-1 results were initially presented at the recent American Society of Clinical Oncology Gastrointestinal Cancers Symposium and discussed during the Cholangiocarcinoma Foundation 2022 meeting held February 23-25 in Salt Lake City, Utah, and virtually.
Can you discuss the mechanism of action of adding durvalumab to gemcitabine/cisplatin chemotherapy in biliary duct cancer?
What we have learned through many other tumor types—including lung cancer, breast cancer, and other emerging tumor types—in certain tumors, single-agent monotherapy IOs [immunotherapies] can be very effective. In melanoma, non–small cell lung cancer with high PD-L1 expression, single-agent monotherapy with IO was very effective.
But in many other tumors, which tend to be much more on the colder range, where the immune system is maybe not as activated, you need chemotherapy to trigger the immune cascade. We identified that biliary tract cancer was likely one of the tumors where we needed a chemotherapy foundation combination to trigger the immune cascade, which would then be enhanced with the combination of checkpoint inhibitors. So in this study, we had a chemotherapy foundation with cisplatin/gemcitabine, and then IO with durvalumab was added on top.