Durvalumab boosts survival for small-cell lung cancer but at a high cost

Small cell lung cancer can affect anyone, but it typically affects people who have a long history of smoking cigarettes. – Image licensed from 123RF Images

CANCER DIGEST – Jan. 11, 2026 – A new cost/benefit analysis of an immunotherapy drug that showed significantly longer survival for people with an aggressive form of lung cancer, called small-cell lung cancer, concludes that the treatment might be too expensive to be worth the benefit.

Small-cell lung cancer is one of the most aggressive forms of lung cancer, affecting about 15 percent of all lung cancer cases. It progresses rapidly with poor prognosis. Five-year survival rates range between 25 percent and 30 percent.

In September 2024, The New England Journal of Medicine published the results of the ADRIATIC clinical trial that involved 730 patients with limited stage small-cell lung cancer showing that patients treated with durvalumab in a maintenance regimen following chemotherapy survived an median of 55.9 months compared to 33.4 months for patients who received standard therapy. The maintenance regimen consisted of 1500mg of durvalumab every four weeks for up to 24 months. 

The authors led by Ying Cheng, MD of Peking University Cancer Hospital and Institute in Bejing, China, concluded that adding durvalumab led to significantly longer overall survival and longer progression-free survival than those given standard treatment.

In a cost/benefit analysis of the study published in the Dec. 19, 2025 the journal JCO Global Oncology, researchers led by Chinmay Jani, MD and Gilberto Lopes, MD, at the Sylvester Comprehensive Cancer Center at the University of Miami found that the increased survival benefit of durvalumab comes at a steep price. While acknowledging the real-life benefits of extended survival, meaning more birthdays, more family time, time to live fully, the analysis showed that the cost of durvalumab was $163,722, compared to $25,816 for standard care. 

They then broke it down further in terms of quality of life during those additional 22 months of survival and found the cost-effectiveness ratio was $383,069 per quality-adjusted life year, which is far above the $150,000 per quality-adjusted life year that is the standard for what people are willing to pay. In plain terms, the average cost of the treatment spread over the number of eligible patients would be too high to sustain over time.

“Cost-effectiveness isn’t just a metric. It shapes real-world access,” Dr. Lopes, chief of the Division of Medical Oncology and associate director for global oncology at Sylvester said in a press release. “We need strategies that make innovation sustainable.”

The analysis did find that for a subset of these small-cell lung cancer patients, those with extrathoracic progression, meaning cancer that has spread to other parts of the body beyond the chest, such as bone, liver or brain, the cost benefit reached $151,137 per quality-adjusted life year.

Dr. Lopes, who chairs the Access to Oncology Medicines (ATOM) work group of the Union for International Cancer Control, added that innovation must walk hand in hand with affordability, emphasizing that developing new drugs is only half the battle. Making life-saving therapies accessible to all patients including those in low-income countries must be a part of new therapy development.

Policy changes at Medicare, as well as the newly adopted freedom for the agency to negotiate prices could reshape durvalumab's accessibility. Meanwhile researchers are considering strategies for improving cost-effectiveness through patient selection and alternative dosing schedules.

Sources: University of Miami press release, JCO Global Oncology, and The New England Journal of Medicine