Encephalitis

1976年发现的IL-2，在整个免疫治疗史上，有着不可替代的位置。Rosenberg称之为第一个人类肿瘤有效的免疫治疗方法。IL-2/IL-2R受体里程碑研究 1976年 NCI肿瘤细胞生物学实验室的RobertGallo，使用PHA刺激淋巴细胞产生条件培养基培养骨髓细胞，其中90%的T细胞长达9个月的生存维持。在此之前，原代T细胞无法体外培养，是免疫学发展的巨大瓶颈性技术问题。这个未被纯化的成分称之为T细胞生长因子（TCGF）。条件培养基培养骨髓细胞（文献1）1980年NCI肿瘤细胞生物学实验室的RobertGallo，通过离子交换色谱和凝胶分离，从条件培养基中分离浓缩了TCGF，并且得出了大致的分子量约15KD。纯化IL-2电泳（文献2）1983年日本癌症研究基金会肿瘤研究中心，Junji Hamuro等人，克隆了IL-2的基因，完成了测序工作。人们可以完整的了解这个T细胞生长因子的基因和氨基酸序列等基础信息。但是为什么第一个被克隆的细胞因子成为IL-2而不是IL-1呢？原因是，当初有科学家认为，有另外一个细胞因子刺激了IL-2的产生，那个未知的因子应该是1。IL-2序列（文献3）IL-2受体的发现和克隆 1984年Nature发表了三篇IL-2受体α克隆的文章（文献4，5，6），分别来自于Immunex 公司（2002年Amgen收购），NCI，和日本京都大学。 1986年NIH国立儿童健康与人类发育研究所在Science发表文章（文献7），发现了IL-2另外一个受体p70，1986和1987年还有多篇文章报道IL-2 p70受体。1990年日本东北大学医学院，1991京都大学分别发表文章发现IL-2Rγ（文献8，9）。至此，IL-2受体α，β，γ被发现。之后IL-2和受体的结合，被Stanford的科学家解析。IL-2-IL-2Rα，β，γ复合物结构（文献10）IL-2/IL-2R药物开发 重组IL-21983年IL-2基因被克隆，是IL-2药物开发的里程碑式基础研究，1983年和1984年多个实验室进行了IL-2的大肠杆菌表达。 IL-2临床试验统计（文献16）1984年11月，一个33岁黑色素瘤转移的病人接受重组IL-2治疗，肿瘤消退，此后病人无疾病生存29年。1985年Rosenberg在肝癌转移小鼠模型注射重组IL-2，获得很好的治疗效果（文献11）。1985年Rosenberg等在新英格兰医学杂志报道，使用IL-2和LAK细胞进行了25个癌症转移病人的临床研究。Rosenberg 2014年发文评述IL-2是第一个人类肿瘤有效的免疫治疗方法（文献13）。 1991年诺华与linigen联合研发的重组IL-2药物 Proleukin（Aldesleukin，阿地白介素）被FDA批准治疗转移性肾癌，1998年批准治疗转移性黑色素瘤。但是因为半衰期短，治疗窗口窄，毒副作用大，且同时刺激Treg活化，限制了临床使用。 新型IL-2开发（PEG化，偏向性IL-2） IL-2R有α（CD25），β（CD122），γ（CD132），其中，α为低亲和力受体，且下游无信号传导，β和γ组成中等亲和力的受体，下游可以通过JAK传导信号，在α参与的情况下，亲和力增强为高亲和力受体。IL-2受体（文献17） 从1990s开始，很多的科研单位和企业开始，通过突变改变IL-2和不同受体亚单位亲和力，以增加活力，降低毒性。2000年Bayer 设计了BAY50-4798，选择性结合IL-2Raβγ，减少和IL-2βγ的结合，减少IL-2Rβγ+ NK细胞介导的毒性。但是最终临床治疗和传统IL-2比较，没有改善。BAY50-4798结构及作用（文献14）NKTR-214NKTR-214是由美国Nektar公司开发的一种针对CD122 (IL-2Rβ)抗原的偏向型激动剂,其通过靶向作用于CD8+效应T细胞以刺激肿瘤杀伤T细胞的增殖,从而利用患者自身免疫系统对抗癌症。NKTR-214通过对首个肿瘤免疫药物aldesleukin进行聚乙二醇(PEG)修饰,有效克服了其严重的毒副作用并延长起效时间。THOR-707Synthorx公司（赛诺菲25亿美金收购）产品，通过向宿主细胞转入非天然氨基酸，在该位点实现定点PEG偶联，和IL-2Rα低亲和力，但是和IL-2Rβγ有接近天然的亲和力，选择性激活CD8+T细胞，不激活Treg。NCT04009681，A Study Evaluating Safety and TherapeuticActivity of THOR-707 in Adult Subjects With Advanced or Metastatic Solid Tumors(THOR-707-101)，Phase1/2SHR-1916 12月25日恒瑞偏向性IL-2，SHR-1916获批临床。SHR-1916是恒瑞医药自主研发的全新PEG修饰和位点突变的IL-2分子，可以通过激活JAK1/JAK3/STAT5信号通路，促进CD8⁺T和NK细胞增殖，发挥抗肿瘤作用。Immunocytokine（抗体-IL2偶联） 通过靶向肿瘤抗原抗体将IL-2携带至肿瘤局部，是另外一种策略，可以增加半衰期，增强靶向性，降低毒性。hu14.18-IL2hu14.18-IL2（EMD273063），由EMD Serono研发，是一种抗GD2免疫因子，由抗GD2抗体14.18（抗体）和两分子的IL-2（免疫因子）融合而成的蛋白，主要用于治疗黑色素瘤。临床研究：NCT00590824，Pilothu14.18-IL2 in Resectable Recurrent Stage III or Stage IV Melanoma，phase2 在一些高复发风险的黑色素瘤患者中，使用IC治疗的患者出现了长时间的无瘤生存。 L19-IL2Philogen S.p.A.公司研发，L19靶向细胞外基质（ECM）纤维连接蛋白异构体B-FN的的结构域B（ED-B）。NCT02957019，A PhaseI/II Study of the Tumor-targeting Human L19-IL2 Monoclonal Antibody-cytokineFusion Protein in Combination With Rituximab in Relapsed or Refractory DiffuseLarge B-cell Lymphoma (DLBCL)NCT04362722，IntratumoralAdministration of Daromun in Non-melanoma Skin Cancer Patients (DUNCAN)，phase2Philogen S.p.A.还开发了F16IL2，有多个临床在开展，但是进度未更新。RO6874281RO6874281，来自于Roche，是IL-2突变体与靶向FAP的单抗融合而成的双特异性蛋白，其中靶向肿瘤胶质抗原FAP的单抗用于将蛋白相对准确地定位到肿瘤部位，IL-2突变体部分则偏向性地结合和调控肿瘤微环境中的T细胞表面的IL-2Rβγ二聚体，从而激活微环境中的抗肿瘤免疫效果。 NCT03875079（Metastatic Melanoma），NCT03063762（Metastatic Renal Cell Carcinoma），NCT02627274（联用Trastuzumab or Cetuximab），NCT03386721（实体瘤，联用Atezolizumab），NCT03193190（PDAC）IL-2R抗体 阻断性抗体用于炎症性疾病，非阻断性抗体用于肿瘤免疫治疗。阻断性抗体Zinbryta(daclizumab)AbbVie，Inc.和Biogen适用为有多发性硬化症(MS)的复发型成年患者的治疗白介素-2受体阻断抗体7例严重不良反应，主要为脑炎和脑膜炎，这才紧急启动撤市程序。 IL-2R alpha嵌合体抗体Basiliximab/巴利昔单抗/舒莱Novartis预防首次肾移植术后的急性器官排斥国内注册号：S20171040非阻断性抗体RG6292非阻断性CD25抗体，选择性清除Treg。详细内容可阅读：Roche 新型CD25抗体选择性清除调节性T细胞，增强抗肿瘤免疫参考文献Morgan DA, Ruscetti FW, GalloRC: Selective in vitro growth of T lymphocytes from normal human bone marrows.Science 1976, 193: 1007e1008J.W. Mier, R.C. Gallo,Purification and some characteristics of human T-cell growth factor fromphytohemagglutinin-stimulated lymphocyte-conditioned media, Proc.Natl. Acad.Sci. USA (1980)aniguchi T,et al: Structure andexpression of a cloned cDNA for human interleukin-2. Nature 1983, 302:305e310Cosman, D.et al, (1984).Cloning, sequence and expression of human interleukin-2 receptor. Nature 312,768–771.Leonard, W.J.,etal.(1984).Molecular cloning and expression of cDNAs for the human interleukin-2 receptor.Nature 311, 626–631.Nikaido, T., et al (1984).Molecular cloning of cDNA encoding human interleukin-2 receptor. Nature 311,631–635.Sharon, M., et al. (1986).Novel interleukin-2 receptor subunit detected by cross-linking underhigh-affinity conditions. Science 234, 859–863.Takeshita, T., et al. (1990).An associated molecule, p64, with high-affinity interleukin 2 receptor. Int.Immunol. 2, 477–480.Saito, Y.,et al. (1991).Biochemical evidence for a third chain of the interleukin-2 receptor. J. Biol.Chem. 266, 22186–22191.X. Wang, M. Rickert, K.C.Garcia, Structure of the quaternary complex of interleukin-2 with Its α, ß, andγc Receptors. Science (80-) 310 (2005) 1159 LP–1163Lafreniere R, Rosenberg SA.1985. Successful immunotherapy of murine experimental hepatic metastases withlymphokine activated killer cells and recombinant interleukin 2. Cancer Res45(8):3735–3741.Rosenberg SA, et al. 1985.Observations on the systemic administration of autologous lymphokine-activatedkiller cells and recombinant interleukin-2 to patients with metastatic cancer.N Engl J Med 313(23):1485–1492.Rosenberg SA. 2014. IL-2: thefirst effective immunotherapy for human cancer. J Immunol 192(12):5451–5458.Shanafelt AB, et al. 2000. AT-cell-selective interleukin 2 mutein exhibits potent antitumor activity and iswell tolerated in vivo. Nat Biotechnol 18(11):1197–1202.Carnemolla B, Borsi L, Balza Eet al (2002) Enhancement of the antitumor properties of interleukin-2 byits targeted delivery to the tumor blood vessel extracellular matrix. Blood99(5):1659– 1665Alexy Orozco Valencia，et al，Interleukin-2 as immunotherapeutic in the autoimmune diseases，International Immunopharmacology 81 (2020) 1062962Rosanne Spolski，et al，Biology and regulation of IL-2: from molecular mechanisms to human therapy，Nat Rev Immunol . 2018 Oct;18(10):648-659.本周好文推荐如需转载请联系佰傲谷并在醒目位置注明出处···

流感是一种上呼吸道急性传染病，由流感病毒引起，主要通过感染者的飞沫或呼吸道分泌物传播。流感病毒属于正粘病毒科，基因组为单链RNA。流感大流行是目前公共卫生领域主要问题之一。季节性流感（甲型和乙型流感亚型）极大地威胁着全球公共卫生并影响全球经济。因此，必须将流感样疾病监测和相关疫苗接种作为预防和控制流感的策略。图1 甲型流感病毒颗粒及其组分的结构示意图流感病毒属于正粘病毒科，是单股、负链、分节段的RNA病毒。根据病毒核蛋白和基质蛋白，分为甲、乙、丙、丁（或A、B、C、D）四型。甲型流感病毒：根据病毒表面的血凝未（HA）和神经氨酸酶（NA）的蛋白结构和基因特性，可分分为多种亚型。目前，发现的HA和NA分别有18个（H1-18）和11个（NI-11）亚型。甲型流感病毒宿主众多，除感染人外，在动物中广泛存在，如禽类、猪、马、海豹以及鲸鱼和水貂等。乙型流感病毒：根据HA基因型分为Victoria系和Yamagata系，既往多个流行季在人群中交替流行或混合流行。2020年3月至今，全球几乎未再监测到自然流行的乙型Yamagata系流感病毒株，引起流感季节性流行的病毒主要是甲型流感病毒中的HINI、H3N2亚型及乙型流感病毒中的Victoria系。丙型流感病毒：可感染人、狗和猪，仅导致上呼吸道感染的散发病例。丁型流感病毒：主要感染猪、牛等，尚未发现感染人。因此，甲型和乙型流感病毒是人类监测的主要对象。而据上图Nature子刊发表的文章称，从2020年4月-2021年8月，全球范围内没有再分离出乙型流感病毒B/Yamagata谱系毒株，这意味着该谱系的病毒毒株可能已经灭绝。究其原因，B/Yamagata系的“消失”很大程度与新冠疫情的防控措施——特别是改变生活行为、佩戴口罩以及增加社交距离、外出限制等有关。这些措施对于防控呼吸道传染病都具有同样的效果，所以呼吸道疾病发病数量的减少是突出的表现。那B/Yamagata系的“消失”对疫苗接种有何影响呢？WHO最新发布的南半球三价疫苗推荐中包含的是H3N2、甲型H1N1和BV组分，不含有BY组分。不过处于谨慎起见，WHO今年还是继续提供了4价流感疫苗的组份推荐。具体流感病毒毒株推荐如下：图2 2024—2025年北半球季节性流感疫苗WHO推荐组分那我们到底应该选3价还是4价呢？据《中国流感疫苗预防接种技术指南（2023-2024）》显示，我国批准上市的流感疫苗包括三价灭活疫苗(IIV3)、三价减毒活疫苗(LAIV3)和四价灭活疫苗(IIV4)。对可接种不同类型、不同厂家疫苗产品的人群，可自愿接种任何一种流感疫苗，无优先推荐。另外，美国儿科学会对此的意见亦是无优先推荐。也就是说，打3价和4价都行。1.流感疫苗是应对流感的最佳手段季节性流感全球每年的发病率估计为成人5-10%，儿童为20-30%，导致数百万美元用于疫苗接种计划和患者治疗。虽然大多数感染流感的人症状轻微，康复后无后遗症，但有些人可能会发展为严重疾病，特别是那些患有高风险疾病的人（例如，老年人，孕妇和幼儿）。根据世界卫生组织（WHO）的数据，全球季节性流感流行每年估计造成300万至500万例重症病例和30万至65万人死亡。中国南方省份已现流感抬头趋势。国家流感中心数据显示南方门急诊流感样病例占比ILI% 3.0%(5/16~5/22)快速上升至6.8%(6/13~6/19)，高于2019-2021年同期水平(4.2%、3.1%、4.3%)，流感阳性检出率达23%且以A(H3N2)为主。北方省份仍保持低流行趋势。图3 我国流感样病例检出率流感对全球公共卫生造成重大负担，接种疫苗是减轻这一负担的最有效方法。由于流感病毒经历的快速遗传变化，季节性流感疫苗必须每年重新配制和重新给药，以匹配流行的毒株。因此，必须在每个季节估计疫苗有效性（VE），以量化疫苗性能。VE流感因季节和个体因素（例如年龄和健康状况）而异。即使在流感VE适度的年份，接种疫苗也可以大大降低疾病负担。表1 流感疫苗：降低感染、住院风险2.我国流感疫苗批签发分析据中检院披露的生物制品批签发情况显示，2023年国内流感疫苗批签发339批次（本文仅统计了裂解疫苗及冻干鼻喷疫苗）。按批签发机构看，中检院批签发感疫苗285批次，其中流感病毒裂解疫苗共278批次；另外则是少量的冻干鼻喷流感减毒活疫苗，共7批次。除中检院外，上海市食品药品检验研究院及吉林省药品检验研究院也承担了部分流感疫苗的检验业务。2023年上海市食品药品检验研究院共批签发上海生物制品研究所的四价流感病毒裂解疫苗37批次，吉林省药品检验研究院则批签发长春生物制品研究所的流感病毒裂解疫苗9批次。因此，若是仅统计流感病毒裂解疫苗，则2023年国内共批签发该类疫苗332批次，同比下滑25%（2022年为434批次）。从获批企业来看，涉及10家企业，包括华兰疫苗批签发94批次，北京科兴生物批签发60批次，赛诺菲巴斯德批签发46批次，上海所批签发37批次，长春所批签发35批次，武汉所批签发21批次，浙江天元生物签发18批次，国光生物批签发10批次，江苏金迪克生物批签发8批次，大连雅立峰批签发3批次。图4：2023年国内流感病毒裂解疫苗各企业批签发份额-批次数，2023年批签发数据统计时间段为2023.01.02-2023.12.31（来源：中检院，药时空制图）从价次来看，3价流感病毒裂解疫苗批签发72批次，4价流感病毒裂解疫苗批签发260批次。可见4价流感病毒裂解疫苗占据主要市场份额。图5 2023年流感疫苗批签发批次数3.流感疫苗在研现状，鸡胚裂解仍为主流目前，有三种类型的流感疫苗，即“灭活”、“减毒活疫苗”和“重组HA”疫苗，在不同国家被许可供人使用。根据包含的流感病毒类型，流感疫苗分为三价和四价，三价流感疫苗里包括了甲型H1H1、甲型H3N2和乙型Victoria三种流感病毒的类型，可以预防这三种流感病毒感染。四价流感疫苗比三价多包括了乙型Yamagata流感病毒。虽然季节性流感疫苗的功效在很大程度上取决于它与流行的流感病毒的匹配程度，但目前的裂解疫苗及其基于鸡蛋的生产平台对于以前接触过流感病毒或接种过裂解疫苗的大部分人群来说功能良好。表2 不同流感疫苗生产平台比较表3 欧洲、日本和美国获得许可的流感疫苗一览目前我国共批准上市四种路线流感疫苗，指南无优先推荐。2021年中检院批签发4类流感疫苗(三价灭活流感疫苗IIV3、三价减毒活疫苗RIV3、四价灭活流感疫苗IIV4、三价亚单位流感疫苗LAIV3)，价格上依次为LAIV3、RIV3、IIV4、IIV3。《中国流感疫苗预防接种技术指南(2021-2022)》表示，对可接不同类型、不同厂家疫苗产品的人群，可自愿接种任一种流感疫苗，无优先推荐。目前，我国市售产品大部分为季节性流感病毒裂解疫苗，而流感亚单位疫苗和减毒活疫苗各只有一种。表4 2022-2023国内批签发的流感疫苗厂家一览4.流感疫苗生产工艺全球的流感疫苗主要分为流感灭活疫苗（IIV）、流感减毒活疫苗（LAIV）和重组流感疫苗（RIV）。具体疫苗种类包括基于鸡胚培养的标准剂量流感裂解疫苗和亚单位灭活疫苗、基于细胞培养的流感灭活疫苗、重组流感疫苗、流感减毒活疫苗、基于鸡胚培养的高剂量灭活流感疫苗以及佐剂流感灭活疫苗等。按照疫苗所含组份，分为三价和四价流感疫苗，其中三价流感疫苗组份含有A(H3N2)亚型、A(H1N1)pdm09 亚型和 B 型流感病毒株的一个系，四价流感疫苗组份含 A(H3N2)亚型、A(H1N1)pdm09 亚型和 B(Victoria)系、B(Yamagata)系。但就目前流行趋势来说，BY已经很久没有在全世界范围内出现了。看上去很复杂，我们以目前在我国已上市的流感疫苗为例顺一下。首先，我国当季使用的流感疫苗包括三价灭活流感疫苗（IIV3）、四价灭活流感疫苗（IIV4）和三价减毒活疫苗（LAIV3）。IIV3 和 IIV4 均有 0.25ml 剂型和 0.5ml 剂型两种剂型，LAIV3 为 0.2ml 剂型。灭活流感疫苗（IIV）主要通过鸡胚培养，是目前生产工艺最为成熟、覆盖患者年龄段最广的主流品种。重组流感疫苗（RIV）基于细胞培养，成本低、安全性高，但免疫原性较弱；减毒流感疫苗（LAIV）与前两种肌肉注射的方式不同，通过鼻喷给药可控制呼吸道中流感病毒的繁殖。5.2023年国外四大疫苗巨头营收排行在经历了新冠疫情退潮后的2023年，疫苗行业仍然备受全球瞩目。从热门疫苗品种来看，近三年没有变动，为四大跨国企业统治的四大疫苗品种：默沙东的HPV疫苗、辉瑞的PCV13/20、葛兰素史克的带状疱疹疫苗、赛诺菲的流感疫苗。四大疫苗巨头全球疫苗市场获得了390亿美元收入，比2021年增长了100亿美元。此外，RSV疫苗在2023年上市，成为增长动力强劲的新晋明星。（注：这里未计入中国疫苗企业的销售收入）图6.2023年畅销疫苗排行榜6.2023年我国上市疫苗企业营收排行14家上市的国内上市疫苗企业营收排行如图6，去年疫苗板块与大盘一致，大部分企业营收下跌。图7 我国上市疫苗企业营收排行榜批签发数量前十产品分别为四价流感病毒疫苗、狂犬病疫苗、HPV2、HPV9、百白破疫苗、麻腮风疫苗、乙肝疫苗、AC多糖疫苗、脊髓灰质炎疫苗、乙型脑炎疫苗。7.展望流感与新冠叠加流行后，带来的潜在威胁不容忽视。英国一项研究评估了新冠肺炎病毒与流感等呼吸道病毒合并感染的临床结局，研究纳入了2020年2月6日至2021年12月8日期间累计约21.24万名住院的新冠肺炎成人患者，通过对其中6965名新冠患者进行呼吸道多病原检测发现，8.4%的患者具有多病原感染，与单一新冠病毒感染相比，新冠病毒合并流感病毒感染的住院患者，机械通气风险增加4.14倍，院内死亡的风险增加2.35倍。新冠和流感联合疫苗是未来研发方向，新冠病毒变异株不断出现推动新冠疫情反复爆发，而随着各国防疫政策改变流感病毒再次流行。未来秋冬季将可能出现流感及新冠同时流行，新冠+流感联合疫苗将是重要的研发方向。随着专家对流感疫苗的科普，大家逐步加深对流感病毒的认知，流感疫苗的接种率也将快速提升，相信流感疫苗在国内外销售额排名位置也将前移。PS：扫码下方二维码加小编微信，备注“2023流感疫苗批签发”，即可获取完整的331批次流感疫苗批签发详情表格文件。附：2023年我国流感疫苗批签发情况部分截图（仅统计了裂解疫苗及冻干鼻喷疫苗，来源：中检院，药时空整理）参考文献[1]Chen,Jidang et al.Advances in Development and Application of Influenza Vaccines.Frontiers in immunology vol. 12 711997. 13 Jul. 2021, doi:10.3389/fimmu.2021.711997.[2]Sekiya,Toshiki et al.Selecting and Using the Appropriate Influenza Vaccine for Each Individual.Viruses vol. 13,6 971. 24 May. 2021, doi:10.3390/v13060971.[3]Zhang, Jiayou et al.The Epidemiology of Influenza and the Associated Vaccines Development in China: A Review.Vaccines vol. 10,11 1873. 6 Nov. 2022, doi:10.3390/vaccines10111873.[4]华泰证劵：流感疫苗：平疫疠之苦，安吾民之生。[5]华创证券：创新药系列研究：全球流感爆发，关注流感资产困境反转。[6]预防界生产厂家高达12家，流感疫苗为什么同质化这么严重？识别微信二维码，添加生物制品圈小编，符合条件者即可加入生物制品微信群！请注明：姓名+研究方向！版权声明本公众号所有转载文章系出于传递更多信息之目的，且明确注明来源和作者，不希望被转载的媒体或个人可与我们联系(cbplib@163.com)，我们将立即进行删除处理。所有文章仅代表作者观点，不代表本站立场。

First and only immunotherapy to demonstrate survival benefit in this setting in a global Phase III trial WILMINGTON, Del.--(BUSINESS WIRE)-- Positive high-level results of the ADRIATIC Phase III trial showed AstraZeneca’s IMFINZI® (durvalumab) demonstrated a statistically significant and clinically meaningful improvement in the dual primary endpoints of overall survival (OS) and progression-free survival (PFS) in patients with limited-stage small cell lung cancer (LS-SCLC) who had not progressed following concurrent chemoradiotherapy (cCRT) compared to placebo after cCRT. Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer that typically recurs and progresses rapidly despite initial response to chemotherapy and radiotherapy in LS-SCLC patients.1,2 The prognosis is particularly poor for LS-SCLC, as only 15-30% of these patients will be alive five years after diagnosis.3 Suresh Senan, PhD, Professor of Clinical Experimental Radiotherapy at the Amsterdam University Medical Center, The Netherlands, and principal investigator in the trial said: “Many patients treated for limited-stage small cell lung cancer face disease recurrence and the standard of care has remained unchanged for decades. ADRIATIC is the first global Phase III immunotherapy trial to deliver significant, clinically meaningful improvement in survival in this setting, marking a breakthrough for patients with this devastating disease.” Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: “These exciting results build on the transformative efficacy of IMFINZI in extensive-stage small cell lung cancer and demonstrate the potential to bring a curative-intent immunotherapy treatment to this earlier-stage setting of small cell lung cancer for the first time. These data, together with the PACIFIC data in unresectable, Stage III non-small cell lung cancer, underscore the pioneering role of IMFINZI in the treatment of early lung cancer following chemoradiotherapy.” The safety pro IMFINZI was consistent with its known profile, and no new safety signals were identified. These data will be presented at a forthcoming medical meeting and shared with global regulatory authorities. The second experimental arm testing the efficacy of IMJUDO® (tremelimumab-actl) added to IMFINZI as a secondary endpoint remains blinded and will continue to the next planned analysis. IMFINZI is approved in the US, EU, Japan, China and many other countries around the world for the treatment of extensive-stage SCLC (ES-SCLC) based on the CASPIAN Phase III trial. IMFINZI is also the only approved immunotherapy and the global standard of care in the curative-intent setting of unresectable, Stage III non-small cell lung cancer (NSCLC) in patients whose disease has not progressed after CRT based on the PACIFIC Phase III trial. IMPORTANT SAFETY INFORMATION There are no contraindications for IMFINZI® (durvalumab) or IMJUDO® (tremelimumab-actl). Severe and Fatal Immune-Mediated Adverse Reactions Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions. Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting treatment or after discontinuation. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate clinical chemistries including liver enzymes, creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid function at baseline and before each dose. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. Withhold or permanently discontinue IMFINZI and IMJUDO depending on severity. See USPI Dosing and Administration for specific details. In general, if IMFINZI and IMJUDO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 mg to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy. Immune-Mediated Pneumonitis IMFINZI and IMJUDO can cause immune-mediated pneumonitis, which may be fatal. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation. IMFINZI as a Single Agent In patients who did not receive recent prior radiation, the incidence of immune-mediated pneumonitis was 2.4% (34/1414), including fatal (<0.1%), and Grade 3-4 (0.4%) adverse reactions. In patients who received recent prior radiation, the incidence of pneumonitis (including radiation pneumonitis) in patients with unresectable Stage III NSCLC following definitive chemoradiation within 42 days prior to initiation of IMFINZI in PACIFIC was 18.3% (87/475) in patients receiving IMFINZI and 12.8% (30/234) in patients receiving placebo. Of the patients who received IMFINZI (475), 1.1% were fatal and 2.7% were Grade 3 adverse reactions. The frequency and severity of immune-mediated pneumonitis in patients who did not receive definitive chemoradiation prior to IMFINZI were similar in patients who received IMFINZI as a single agent or with ES-SCLC or BTC when given in combination with chemotherapy. IMFINZI with IMJUDO Immune‑mediated pneumonitis occurred in 1.3% (5/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.3%) and Grade 3 (0.2%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated pneumonitis occurred in 3.5% (21/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.5%), and Grade 3 (1%) adverse reactions. Immune-Mediated Colitis IMFINZI with IMJUDO and platinum-based chemotherapy can cause immune-mediated colitis, which may be fatal. IMFINZI and IMJUDO can cause immune-mediated colitis that is frequently associated with diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies. IMFINZI as a Single Agent Immune-mediated colitis occurred in 2% (37/1889) of patients receiving IMFINZI, including Grade 4 (<0.1%) and Grade 3 (0.4%) adverse reactions. IMFINZI with IMJUDO Immune‑mediated colitis or diarrhea occurred in 6% (23/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (3.6%) adverse reactions. Intestinal perforation has been observed in other studies of IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated colitis occurred in 6.5% (39/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including fatal (0.2%) and Grade 3 (2.5%) adverse reactions. Intestinal perforation and large intestine perforation were reported in 0.1% of patients. Immune-Mediated Hepatitis IMFINZI and IMJUDO can cause immune-mediated hepatitis, which may be fatal. IMFINZI as a Single Agent Immune-mediated hepatitis occurred in 2.8% (52/1889) of patients receiving IMFINZI, including fatal (0.2%), Grade 4 (0.3%) and Grade 3 (1.4%) adverse reactions. IMFINZI with IMJUDO Immune‑mediated hepatitis occurred in 7.5% (29/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.8%), Grade 4 (0.3%) and Grade 3 (4.1%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated hepatitis occurred in 3.9% (23/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.3%), Grade 4 (0.5%), and Grade 3 (2%) adverse reactions. Immune-Mediated Endocrinopathies Adrenal Insufficiency: IMFINZI and IMJUDO can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. IMFINZI as a Single Agent Immune-mediated adrenal insufficiency occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated adrenal insufficiency occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated adrenal insufficiency occurred in 2.2% (13/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.8%) adverse reactions. Hypophysitis: IMFINZI and IMJUDO can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field cuts. Hypophysitis can cause hypopituitarism. Initiate symptomatic treatment including hormone replacement as clinically indicated. IMFINZI as a Single Agent Grade 3 hypophysitis/hypopituitarism occurred in <0.1% (1/1889) of patients who received IMFINZI. IMFINZI with IMJUDO Immune-mediated hypophysitis/hypopituitarism occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated hypophysitis occurred in 1.3% (8/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions. Thyroid Disorders (Thyroiditis, Hyperthyroidism, and Hypothyroidism): IMFINZI and IMJUDO can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement therapy for hypothyroidism or institute medical management of hyperthyroidism as clinically indicated. IMFINZI as a Single Agent Immune-mediated thyroiditis occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. Immune-mediated hyperthyroidism occurred in 2.1% (39/1889) of patients receiving IMFINZI. Immune-mediated hypothyroidism occurred in 8.3% (156/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated thyroiditis occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO. Immune-mediated hyperthyroidism occurred in 4.6% (18/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions. Immune-mediated hypothyroidism occurred in 11% (42/388) of patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated thyroiditis occurred in 1.2% (7/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy. Immune-mediated hyperthyroidism occurred in 5% (30/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions. Immune-mediated hypothyroidism occurred in 8.6% (51/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions. Type 1 Diabetes Mellitus, which can present with diabetic ketoacidosis: Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated. IMFINZI as a Single Agent Grade 3 immune-mediated Type 1 diabetes mellitus occurred in <0.1% (1/1889) of patients receiving IMFINZI. IMFINZI with IMJUDO Two patients (0.5%, 2/388) had events of hyperglycemia requiring insulin therapy that had not resolved at last follow-up. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated Type 1 diabetes mellitus occurred in 0.5% (3/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including Grade 3 (0.3%) adverse reactions. Immune-Mediated Nephritis with Renal Dysfunction IMFINZI and IMJUDO can cause immune-mediated nephritis. IMFINZI as a Single Agent Immune-mediated nephritis occurred in 0.5% (10/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated nephritis occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.5%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated nephritis occurred in 0.7% (4/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions. Immune-Mediated Dermatology Reactions IMFINZI and IMJUDO can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis (TEN), has occurred with PD-1/L-1 and CTLA-4 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes. IMFINZI as a Single Agent Immune-mediated rash or dermatitis occurred in 1.8% (34/1889) of patients receiving IMFINZI, including Grade 3 (0.4%) adverse reactions. IMFINZI with IMJUDO Immune-mediated rash or dermatitis occurred in 4.9% (19/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated rash or dermatitis occurred in 7.2% (43/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions. Immune-Mediated Pancreatitis IMFINZI in combination with IMJUDO can cause immune-mediated pancreatitis. Immune-mediated pancreatitis occurred in 2.3% (9/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions. Other Immune-Mediated Adverse Reactions The following clinically significant, immune-mediated adverse reactions occurred at an incidence of less than 1% each in patients who received IMFINZI and IMJUDO or were reported with the use of other immune-checkpoint inhibitors. Cardiac/vascular: Myocarditis, pericarditis, vasculitis. Nervous system: Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barré syndrome, nerve paresis, autoimmune neuropathy. Ocular: Uveitis, iritis, and other ocular inflammatory toxicities can occur. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada-like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss. Gastrointestinal: Pancreatitis including increases in serum amylase and lipase levels, gastritis, duodenitis. Musculoskeletal and connective tissue disorders: Myositis/polymyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatic. Endocrine: Hypoparathyroidism. Other (hematologic/immune): Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection. Infusion-Related Reactions IMFINZI and IMJUDO can cause severe or life-threatening infusion-related reactions. Monitor for signs and symptoms of infusion-related reactions. Interrupt, slow the rate of, or permanently discontinue IMFINZI and IMJUDO based on the severity. See USPI Dosing and Administration for specific details. For Grade 1 or 2 infusion-related reactions, consider using pre-medications with subsequent doses. IMFINZI as a Single Agent Infusion-related reactions occurred in 2.2% (42/1889) of patients receiving IMFINZI, including Grade 3 (0.3%) adverse reactions. IMFINZI with IMJUDO Infusion-related reactions occurred in 10 (2.6%) patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Infusion-related reactions occurred in 2.9% (17/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions. Complications of Allogeneic HSCT after IMFINZI Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/L-1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host-disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/L-1 blockade and allogeneic HSCT. Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/L-1 blocking antibody prior to or after an allogeneic HSCT. Embryo-Fetal Toxicity Based on their mechanism of action and data from animal studies, IMFINZI and IMJUDO can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. In females of reproductive potential, verify pregnancy status prior to initiating IMFINZI and IMJUDO and advise them to use effective contraception during treatment with IMFINZI and IMJUDO and for 3 months after the last dose of IMFINZI and IMJUDO. Lactation There is no information regarding the presence of IMFINZI and IMJUDO in human milk; however, because of the potential for serious adverse reactions in breastfed infants from IMFINZI and IMJUDO, advise women not to breastfeed during treatment and for 3 months after the last dose. Adverse Reactions In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), the most common adverse reactions (≥20%) were cough (40%), fatigue (34%), pneumonitis or radiation pneumonitis (34%), upper respiratory tract infections (26%), dyspnea (25%), and rash (23%). The most common Grade 3 or 4 adverse reactions (≥3%) were pneumonia (7%) and pneumonitis/radiation pneumonitis (3.4%). In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), discontinuation due to adverse reactions occurred in 15% of patients in the IMFINZI arm. Serious adverse reactions occurred in 29% of patients receiving IMFINZI. The most frequent serious adverse reactions (≥2%) were pneumonitis or radiation pneumonitis (7%) and pneumonia (6%). Fatal pneumonitis or radiation pneumonitis and fatal pneumonia occurred in <2% of patients and were similar across arms. In patients with mNSCLC in the POSEIDON study receiving IMFINZI and IMJUDO plus platinum-based chemotherapy (n=330), the most common adverse reactions (occurring in ≥20% of patients) were nausea (42%), fatigue (36%), musculoskeletal pain (29%), decreased appetite (28%), rash (27%), and diarrhea (22%). In patients with mNSCLC in the POSEIDON study receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy (n=330), permanent discontinuation of IMFINZI or IMJUDO due to an adverse reaction occurred in 17% of patients. Serious adverse reactions occurred in 44% of patients, with the most frequent serious adverse reactions reported in at least 2% of patients being pneumonia (11%), anemia (5%), diarrhea (2.4%), thrombocytopenia (2.4%), pyrexia (2.4%), and febrile neutropenia (2.1%). Fatal adverse reactions occurred in a total of 4.2% of patients. In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), the most common adverse reactions (≥20%) were nausea (34%), fatigue/asthenia (32%), and alopecia (31%). The most common Grade 3 or 4 adverse reaction (≥3%) was fatigue/asthenia (3.4%). In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), IMFINZI was discontinued due to adverse reactions in 7% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 31% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 1% of patients were febrile neutropenia (4.5%), pneumonia (2.3%), anemia (1.9%), pancytopenia (1.5%), pneumonitis (1.1%), and COPD (1.1%). Fatal adverse reactions occurred in 4.9% of patients receiving IMFINZI plus chemotherapy. In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), the most common adverse reactions (occurring in ≥20% of patients) were fatigue (42%), nausea (40%), constipation (32%), decreased appetite (26%), abdominal pain (24%), rash (23%), and pyrexia (20%). In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), discontinuation due to adverse reactions occurred in 6% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 47% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 2% of patients were cholangitis (7%), pyrexia (3.8%), anemia (3.6%), sepsis (3.3%) and acute kidney injury (2.4%). Fatal adverse reactions occurred in 3.6% of patients receiving IMFINZI plus chemotherapy. These include ischemic or hemorrhagic stroke (4 patients), sepsis (2 patients), and upper gastrointestinal hemorrhage (2 patients). In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), the most common adverse reactions (occurring in ≥20% of patients) were rash (32%), diarrhea (27%), fatigue (26%), pruritus (23%), musculoskeletal pain (22%), and abdominal pain (20%). In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), serious adverse reactions occurred in 41% of patients. Serious adverse reactions in >1% of patients included hemorrhage (6%), diarrhea (4%), sepsis (2.1%), pneumonia (2.1%), rash (1.5%), vomiting (1.3%), acute kidney injury (1.3%), and anemia (1.3%). Fatal adverse reactions occurred in 8% of patients who received IMJUDO in combination with durvalumab, including death (1%), hemorrhage intracranial (0.5%), cardiac arrest (0.5%), pneumonitis (0.5%), hepatic failure (0.5%), and immune-mediated hepatitis (0.5%). Permanent discontinuation of treatment regimen due to an adverse reaction occurred in 14% of patients. The safety and effectiveness of IMFINZI and IMJUDO have not been established in pediatric patients. Indications: IMFINZI is indicated for the treatment of adult patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy. IMFINZI, in combination with IMJUDO and platinum-based chemotherapy, is indicated for the treatment of adult patients with metastatic NSCLC with no sensitizing epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) genomic tumor aberrations. IMFINZI, in combination with etoposide and either carboplatin or cisplatin, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). IMFINZI, in combination with gemcitabine and cisplatin, is indicated for the treatment of adult patients with locally advanced or metastatic biliary tract cancer (BTC). IMFINZI in combination with IMJUDO is indicated for the treatment of adult patients with unresectable hepatocellular carcinoma (uHCC). Please see Full Prescribing Information including Medication Guide for IMFINZI and IMJUDO. You may report side effects related to AstraZeneca products by clicking here. Notes Small cell lung cancer Lung cancer is the leading cause of cancer death among men and women and accounts for about one-fifth of all cancer deaths.4 Lung cancer is broadly split into NSCLC and SCLC, with about 15% of cases classified as SCLC.5 LS-SCLC (Stage I-III) is classified as SCLC that is generally only in one lung or one side of the chest.6 LS-SCLC accounts for approximately 30% of SCLC diagnoses and the prognosis remains poor despite curative-intent treatment with standard-of-care cCRT.7 ADRIATIC The ADRIATIC trial is a randomized, double-blind, placebo-controlled, multi-center global Phase III trial evaluating IMFINZI monotherapy and IMFINZI plus IMJUDO versus placebo in the treatment of 730 patients with LS-SCLC who had not progressed following cCRT. In the experimental arms, patients were randomized to receive a 1500mg fixed dose of IMFINZI with or without IMJUDO 75mg every four weeks for up to four doses/cycles each, followed by IMFINZI every four weeks for up to 24 months. The dual primary endpoints are PFS and OS for IMFINZI monotherapy versus placebo. Key secondary endpoints included OS and PFS for IMFINZI plus IMJUDO versus placebo, safety and quality of life measures. The trial includes 164 centers in 19 countries across North and South America, Europe and Asia. IMFINZI® (durvalumab) IMFINZI® (durvalumab) is a human monoclonal antibody that binds to the PD-L1 protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins, countering the tumor’s immune-evading tactics and releasing the inhibition of immune responses. In addition to its indications in unresectable, Stage III NSCLC and ES-SCLC, IMFINZI is currently approved in a number of countries in combination with a short course of IMJUDO and chemotherapy for the treatment of metastatic NSCLC. IMFINZI is also approved in a number of countries in combination with chemotherapy in locally advanced or metastatic biliary tract cancer and in combination with IMJUDO in unresectable hepatocellular carcinoma (HCC). IMFINZI is also approved as a monotherapy in unresectable HCC in Japan and the EU and in previously treated patients with advanced bladder cancer in a small number of countries. Since the first approval in May 2017, more than 220,000 patients have been treated with IMFINZI. As part of a broad development program, IMFINZI is being tested as a single treatment and in combinations with other anti-cancer treatments for patients with SCLC, NSCLC, bladder cancer, breast cancer, several gastrointestinal cancers and other solid tumors. IMJUDO® (tremelimumab-actl) IMJUDO® (tremelimumab-actl) is a human monoclonal antibody that targets the activity of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). IMJUDO blocks the activity of CTLA-4, contributing to T-cell activation, priming the immune response to cancer and fostering cancer cell death. In addition to its approved indications in combination with IMFINZI in liver and lung cancers, the combination of IMJUDO and IMFINZI is being evaluated across multiple tumor types including locoregional HCC (EMERALD-3) and bladder cancer (VOLGA and NILE). AstraZeneca in lung cancer AstraZeneca is working to bring patients with lung cancer closer to cure through the detection and treatment of early-stage disease, while also pushing the boundaries of science to improve outcomes in the resistant and advanced settings. By defining new therapeutic targets and investigating innovative approaches, the Company aims to match medicines to the patients who can benefit most. The Company’s comprehensive portfolio includes leading lung cancer medicines and the next wave of innovations, including osimertinib and gefitinib; IMFINZI and IMJUDO; fam-trastuzumab deruxtecan-nxki and datopotamab deruxtecan in collaboration with Daiichi Sankyo; savolitinib in collaboration with HUTCHMED; as well as a pipeline of potential new medicines and combinations across diverse mechanisms of action. AstraZeneca is a founding member of the Lung Ambition Alliance, a global coalition working to accelerate innovation and deliver meaningful improvements for people with lung cancer, including and beyond treatment. AstraZeneca in immuno-oncology (IO) AstraZeneca is a pioneer in introducing the concept of immunotherapy into dedicated clinical areas of high unmet medical need. The Company has a comprehensive and diverse IO portfolio and pipeline anchored in immunotherapies designed to overcome evasion of the anti-tumor immune response and stimulate the body’s immune system to attack tumors. AstraZeneca strives to redefine cancer care and help transform outcomes for patients with IMFINZI as a monotherapy and in combination with IMJUDO as well as other novel immunotherapies and modalities. The Company is also investigating next-generation immunotherapies like bispecific antibodies and therapeutics that harness different aspects of immunity to target cancer, including cell therapy and T cell engagers. AstraZeneca is pursuing an innovative clinical strategy to bring IO-based therapies that deliver long-term survival to new settings across a wide range of cancer types. The Company is focused on exploring novel combination approaches to help prevent treatment resistance and drive longer immune responses. With an extensive clinical program, the Company also champions the use of IO treatment in earlier disease stages, where there is the greatest potential for cure. AstraZeneca in oncology AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients. The Company's focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyze changes in the practice of medicine and transform the patient experience. AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death. About AstraZeneca AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines in Oncology, Rare Diseases, and Biopharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit and follow us on social media @AstraZeneca. References National Cancer Institute. NCI Dictionary - Small Cell Lung Cancer. Available at: . Accessed April 2024. Qin A and Kalemkerian GP. Treatment Options for Relapsed Small-Cell Lung Cancer: What Progress Have We Made? J Oncol Pract. 2018;14(6):369-370. Bebb DG, et al. Symptoms and Experiences with Small Cell Lung Cancer: A Mixed Methods Study of Patients and Caregivers. Pulm Ther. 2023:9;435-450. World Health Organization. International Agency for Research on Cancer. Lung Fact Sheet. Available at: . Accessed April 2024. LUNGevity Foundation. Types of Lung Cancer. Available at: . Accessed April 2024. American Cancer Society. Treatment Choices by Stage for Small Cell Lung Cancer. Available at: Accessed April 2024. Senan S, et al. ADRIATIC: A phase III trial of durvalumab ± tremelimumab after concurrent chemoradiation for patients with limited stage small cell lung cancer. Ann Oncol. 2019;30(suppl. 2):ii25. US-88063 Last Updated 4/24 View source version on businesswire.com: Contacts Media Inquiries Brendan McEvoy +1 302 885 2677 Chelsea Tressler +1 302 885 2677 US Media Mailbox: usmediateam@astrazeneca.com Source: AstraZeneca View this news release online at: