The current state of knowledge on small cell and non-small cell lung cancer and the position of durvalumab immunotherapy in lung cancer treatment. A review. Review article

Main Article Content

Kamil Poboży
Julia Domańska
Paweł Domański


Lung cancer is the second most frequently diagnosed cancer and the leading cause of cancer-related deaths in the world. These statistics make lung cancer one of the most important targets for modern medicine.

The identification of multiple risk factors, including tobacco smoking, has been fundamental in understanding the disease. Late-stage detection is a significant contributor to the high mortality rate of lung cancer. Nonetheless, the role of screening is still debatable. The selection of therapy is primarily based on distinguishing between small-cell and non-small cell lung cancer. Despite the major differences in treatment, in both types in specific situations the treatment involves durvalumab – a monoclonal antibody targeting the programmed cell death ligand 1 molecule, which is often present on tumor cells and protects them against the patient’s immune system. The efficacy of durvalumab has been demonstrated in two randomized, multicenter clinical trials.

The aim of this study is to summarize the current state of knowledge about lung cancer and durvalumab. Despite the current 5-year survival rate of 19% in lung cancer, the development of immunotherapeutics such as durvalumab may be the key to improving the unfavorable prognosis of lung cancer in the future.


Download data is not yet available.


Metrics Loading ...

Article Details

How to Cite
Poboży K, Domańska J, Domański P. The current state of knowledge on small cell and non-small cell lung cancer and the position of durvalumab immunotherapy in lung cancer treatment. A review. OncoReview [Internet]. 2023Jan.24 [cited 2023Dec.1];12(4(48):75-2. Available from:


1. Mattiuzzi C, Lippi G. Current Cancer Epidemiology. J Epidemiol Glob Health. 2019; 9(4): 217-22.
2. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249.
3. Schabath MB, Cote ML. Cancer Progress and Priorities: Lung Cancer. Cancer Epidemiol Biomarkers Prev. 2019; 28(10): 1563-79.
4. Shim J, Brindle L, Simon M, George S. A systematic review of symptomatic diagnosis of lung cancer. Fam Pract. 2014; 31(2): 137-48.
5. Kocher F, Hilbe W, Seeber A et al. Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry. Lung Cancer. 2015; 87(2): 193-200.
6. Fischer BM, Mortensen J, Hansen H et al. Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial. Thorax. 2011; 66(4): 294-300.
7. Saettele TM, Ost DE. Multimodality systematic approach to mediastinal lymph node staging in non-small cell lung cancer. Respirology. 2014; 19(6): 800-8.
8. Darling GE, Maziak DE, Inculet RI et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol. 2011; 6(8): 1367-72.
9. Travis WD, Brambilla E, Nicholson AG et al. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015; 10(9): 1243-60.
10. Travis WD, Brambilla E, Burke AP et al. Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J Thorac Oncol. 2015; 10(9): 1240-2.
11. Feng SH, Yang ST. The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and limitations with CT image demonstrations. Diagn Interv Radiol. 2019; 25(4): 270-9.
12. Blandin Knight S, Crosbie PA, Balata H et al. Progress and prospects of early detection in lung cancer. Open Biol. 2017; 7(9): 170070.
13. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019; 69(1): 7-34.
14. Howlader N, Noone AM, Krapcho M et al. (ed). (2013) SEER cancer statistics review, 1975–2010, National Cancer Institute. Bethesda (access: 22.03.2023).
15. Torre LA, Siegel RL, Jemal A. Lung Cancer Statistics. Adv Exp Med Biol. 2016; 893: 1-19.
16. National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5): 395-409.
17. National Lung Screening Trial Research T, Aberle DR, Berg CD, Black WC et al. The National Lung Screening Trial: overview and study design. Radiology. 2011; 258(1): 243-53.
18. Yousaf-Khan U, van der Aalst C, de Jong PA et al. Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval. Thorax. 2017; 72(1): 48-56.
19. Walter JE, Heuvelmans MA, de Jong PA et al. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol. 2016; 17(7): 907-16.
20. Han D, Heuvelmans MA, van der Aalst CM et al. New Fissure-Attached Nodules in Lung Cancer Screening: A Brief Report From The NELSON Study. J Thorac Oncol. 2020; 15(1): 125-9.
21. Pastorino U, Silva M, Sestini S et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol. 2019; 30(10): 1672.
22. Becker N, Motsch E, Trotter A et al. Lung cancer mortality reduction by LDCT screening-Results from the randomized German LUSI trial. Int J Cancer. 2020; 146(6): 1503-13.
23. Soda H, Tomita H, Kohno S et al. Limitation of annual screening chest radiography for the diagnosis of lung cancer. A retrospective study. Cancer. 1993; 72(8): 2341-6.
24. Prorok PC, Andriole GL, Bresalier RS et al. Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials. 2000; 21(6 suppl): 273S-309S.
25. Reich JM. A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. Thorax. 2008; 63(4): 377-83.
26. Duma N, Santana-Davila R, Molina JR. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin Proc. 2019; 94(8): 1623-40.
27. Kalemkerian GP, Loo BW, Akerley W et al. NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018. J Natl Compr Canc Netw. 2018; 16(10): 1171-82.
28. Ettinger DS, Wood DE, Aisner DL et al. Non-Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022; 20(5): 497-530.
29. Chinese guidelines for diagnosis and treatment of primary lung cancer 2018 (English version). Chin J Cancer Res. 2019; 31(1): 1-28.
30. Fruh M, De Ruysscher D, Popat S et al. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24(suppl 6): vi99-105.
31. Dingemans AC, Fruh M, Ardizzoni A et al. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021; 32(7): 839-53.
32. Zhao H, Ren D, Liu H et al. Comparison and discussion of the treatment guidelines for small cell lung cancer. Thorac Cancer. 2018; 9(7): 769-74.
33. Men Y, Luo Y, Zhai Y et al. The role of postoperative radiotherapy (PORT) in combined small cell lung cancer (C-SCLC). Oncotarget. 2017; 8(30): 48922-9.
34. Roth BJ, Johnson DH, Einhorn LH et al. Randomized study of cyclophosphamide, doxorubicin, and vincristine versus etoposide and cisplatin versus alternation of these two regimens in extensive small-cell lung cancer: a phase III trial of the Southeastern Cancer Study Group. J Clin Oncol. 1992; 10(2): 282-91.
35. Sundstrom S, Bremnes RM, Kaasa S et al. Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up. J Clin Oncol. 2002; 20(24): 4665-72.
36. Fukuoka M, Furuse K, Saijo N et al. Randomized trial of cyclophosphamide, doxorubicin, and vincristine versus cisplatin and etoposide versus alternation of these regimens in small-cell lung cancer. J Natl Cancer Inst. 1991; 83(12): 855-61.
37. Horn L, Mansfield AS, Szczesna A et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small Cell Lung Cancer. N Engl J Med. 2018; 379(23): 2220-9.
38. Paz-Ares L, Dvorkin M, Chen Y et al. Durvalumab plus platinum-etoposide versus platinum-etoposide in first line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019; 394(10212): 1929-39.
39. Goldman JW, Dvorkin M, Chen Y et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. 2021; 22(1): 51-65.
40. Midthun DE. Overview of the initial treatment and prognosis of lung cancer. UpToDate, May 02, 2022.
41. Takahashi T, Yamanaka T, Seto T et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2017; 18(5): 663-71.
42. Ettinger DS, Wood DE, Aggarwal C et al. NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 1.2020. J Natl Compr Canc Netw. 2019; 17(12): 1464-72.
43. Osmani L, Askin F, Gabrielson E et al. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): Moving from targeted therapy to immunotherapy. Semin Cancer Biol. 2018; 52(Pt 1): 103-9.
44. Imyanitov EN, Iyevleva AG, Levchenko EV. Molecular testing and targeted therapy for non-small cell lung cancer: Current status and perspectives. Crit Rev Oncol Hematol. 2021; 157: 103194.
45. Lin A. Cancer immunotherapy: an evolving paradigm. J Zhejiang Univ Sci B. 2022; 23(10): 791-2.
46. Bayraktar S, Batoo S, Okuno S et al. Immunotherapy in breast cancer. J Carcinog. 2019; 18: 2. Published 2019 May 23.
47. Kinoshita T, Terai H, Yaguchi T. Clinical Efficacy and Future Prospects of Immunotherapy in Lung Cancer. Life (Basel). 2021; 11(10): 1029.
48. Pennock GK, Chow LQ. The Evolving Role of Immune Checkpoint Inhibitors in Cancer Treatment. Oncologist. 2015; 20(7): 812-22.
49. Zhang Y, Zhang Z. The history and advances in cancer immunotherapy: understanding the characteristics of tumor-infiltrating immune cells and their therapeutic implications. Cell Mol Immunol. 2020; 17(8): 807-21.
50. Abbott M, Ustoyev Y. Cancer and the Immune System: The History and Background of Immunotherapy. Semin Oncol Nurs. 2019; 35(5): 150923.
51. PD-L1 regulates the development, maintenance, and function of induced regulatory T cells. J Exp Med. 2009; 206(13): 3015-29.
52. Arasanz H, Gato-Cañas M, Zuazo M et al. PD1 signal transduction pathways in T cells. Oncotarget. 2017; 8(31): 51936-45.
53. Amarnath S, Mangus CW, Wang JC et al. The PDL1-PD1 axis converts human TH1 cells into regulatory T cells. Sci Transl Med. 2011; 3(111): 111ra120.
54. Kinter AL, Godbout EJ, McNally JP et al. The common gamma-chain cytokines IL-2, IL-7, IL-15, and IL-21 induce the expression of programmed death-1 and its ligands. J Immunol. 2008; 181(10): 6738-46.
55. Spranger S, Spaapen RM, Zha Y et al. Up-regulation of PD-L1, IDO, and T(regs) in the melanoma tumor microenvironment is driven by CD8(+) T cells. Sci Transl Med. 2013; 5(200): 200ra116.
56. Lei Q, Wang D, Sun K et al. Resistance Mechanisms of Anti-PD1/PDL1 Therapy in Solid Tumors. Front Cell Dev Biol. 2020; 8: 672.
57. Sharpe AH, Pauken KE. The diverse functions of the PD1 inhibitory pathway. Nat Rev Immunol. 2018; 18(3): 153-67.
58. Product Information. IMFINZI. IMFINZI, INN-durvalumab (
59. Faivre-Finn C, Vicente D, Kurata T et al. Four-Year Survival With Durvalumab After Chemoradiotherapy in Stage III NSCLC-an Update From the PACIFIC Trial. J Thorac Oncol. 2021; 16(5): 860-7.
60. Antonia SJ, Villegas A, Daniel D et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017; 377(20): 1919-29.
61. Rizvi NA, Cho BC, Reinmuth N et al. Durvalumab With or Without Tremelimumab vs Standard Chemotherapy in First-line Treatment of Metastatic Non-Small Cell Lung Cancer: The MYSTIC Phase 3 Randomized Clinical Trial. JAMA Oncol. 2020; 6(5): 661-74.
62. Garon EB, Cho BC, Reinmuth N et al. Patient-Reported Outcomes with Durvalumab With or Without Tremelimumab Versus Standard Chemotherapy as First-Line Treatment of Metastatic Non-Small-Cell Lung Cancer (MYSTIC). Clin Lung Cancer. 2021; 22(4): 301 12.e8.
63. Meijer JJ, Leonetti A, Airò G et al. Small cell lung cancer: Novel treatments beyond immunotherapy. Semin Cancer Biol. 2022; S1044-579X(22)00115-8.
64. Wang M, Herbst RS, Boshoff C. Toward personalized treatment approaches for non-small-cell lung cancer. Nat Med. 2021; 27(8): 1345-56.
65. Murai J, Huang SY, Das BB et al. Trapping of PARP1 and PARP2 by Clinical PARP Inhibitors. Cancer Res. 2012; 72(21): 5588-99.
66. Byers LA, Wang J, Nilsson MB et al. Proteomic profiling identifies dysregulated pathways in small cell lung cancer and novel therapeutic targets including PARP1. Cancer Discov. 2012; 2(9): 798-811.
67. Yang S, Zhang Z, Wang Q. Emerging therapies for small cell lung cancer. J Hematol Oncol. 2019; 12(1): 47.
68. Sen T, Gay CM, Byers LA. Targeting DNA damage repair in small cell lung cancer and the biomarker landscape. Transl Lung Cancer Res. 2018; 7(1): 50-68.
69. Melichar B, Adenis A, Lockhart AC et al. Safety and activity of alisertib, an investigational aurora kinase A inhibitor, in patients with breast cancer, small-cell lung cancer, non-small-cell lung cancer, head and neck squamous-cell carcinoma, and gastro oesophageal adenocarcinoma: a five-arm phase 2 study. Lancet Oncol. 2015; 16(4): 395-405.
70. Lochmann TL, Floros KV, Naseri M et al. Venetoclax Is Effective in Small-Cell Lung Cancers with High BCL-2 Expression. Clin Cancer Res. 2018; 24(2): 360-9.
71. Santamaría Nuñez G, Robles CM, Giraudon C et al. Lurbinectedin Specifically Triggers the Degradation of Phosphorylated RNA Polymerase II and the Formation of DNA Breaks in Cancer Cells. Mol Cancer Ther. 2016; 15(10): 2399-412.
72. Trigo J, Subbiah V, Besse B et al. Lurbinectedin as second-line treatment for patients with small-cell lung cancer: a single-arm, open-label, phase 2 basket trial. Lancet Oncol. 2020; 21(5): 645-54.
73. Luo H, Shan J, Zhang H et al. Targeting the epigenetic processes to enhance antitumor immunity in small cell lung cancer. Semin Cancer Biol. 2022; S1044-579X(22)00045-1.
74. Yin X, Yang J, Wang H et al. Non-coding genome in small cell lung cancer between theoretical view and clinical applications. Semin Cancer Biol. 2022; S1044-579X(22)00080-3.
75. Lam LT, Lin X, Faivre EJ et al. Vulnerability of Small-Cell Lung Cancer to Apoptosis Induced by the Combination of BET Bromodomain Proteins and BCL2 Inhibitors. Mol Cancer Ther. 2017; 16(8): 1511-20.
76. Fukumura D, Kloepper J, Amoozgar Z et al. Enhancing cancer immunotherapy using antiangiogenics: opportunities and challenges. Nat Rev Clin Oncol. 2018; 15(5): 325-40.
77. Apatinib as maintenance therapy following standard first-line chemotherapy in extensive disease small cell lung cancer: A phase II single-arm trial. Thorac Cancer. 2022; 13(4): 557-62.