Canakinumab with chemoradiation and durvalumab consolidation in unresectable stage III non-small cell lung cancer: the phase I/II CHORUS trial

Abstract

CHORUS (NCT04905316) was an open-label, non-randomized, single-arm phase I/II trial of the anti-IL-1beta monoclonal antibody canakinumab given with concurrent chemoradiotherapy and continued with anti-PD-L1 durvalumab consolidation in unresectable stage III non-small cell lung cancer. The primary endpoint was 24-month progression-free survival (PFS) from radiotherapy initiation; secondary endpoints included overall survival, objective response rate, and safety. Forty-one patients were enrolled, 37 received canakinumab, and 32 comprised the prespecified efficacy population. At a median follow-up of 25 months, 24-month PFS was 67% (95% confidence interval, 52–88); the lower bound of the prespecified one-sided 90% confidence interval was 56.5%, exceeding the 46% historical benchmark, and the primary endpoint was met. Twelve- and 24-month overall survival were 93% and 73%, respectively, and the confirmed objective response rate was 81%. Canakinumab-related grade 3–4 events included neutropenia (n = 5), febrile neutropenia (n = 1), lymphopenia (n = 1), lung infection (n = 1), fatigue (n = 1), and hypertension (n = 1); no canakinumab-related deaths occurred. Pneumonitis of any attribution occurred in 9 of 37 patients (24%; grade 2, n = 7; grade 3, n = 2). Peripheral immune cell profiling showed attenuated expansion of myeloid-derived suppressor cells and CTLA-4-expressing CD8 + T-cell subsets among responders. Circulating tumor DNA cleared by week 6 in 20 of 30 evaluable patients (66%). These findings support randomized evaluation of interleukin-1β blockade in this setting. IL-1β targeting may attenuate myeloid-suppressive pathways and support antitumor immunity. Here, the authors report a phase I/II trial of concurrent canakinumab, an anti-IL-1β antibody, with chemoradiotherapy, followed by consolidation canakinumab plus the anti-PD-L1 antibody durvalumab, in patients with unresectable stage III non-small cell lung cancer.