Summary
In the single-arm MDT-BRIDGE phase 2 study, 142 people with resectable or borderline resectable non-small-cell lung cancer received durvalumab plus chemotherapy before multidisciplinary teams directed them to surgery or chemoradiotherapy. Surgery was performed in 74.6%; survival follow-up is still early.
A global phase 2 study tested a treatment pathway in which people with resectable or borderline resectable non-small-cell lung cancer (NSCLC) began with durvalumab and chemotherapy, then had their eligibility for surgery reassessed by a multidisciplinary team. Of 142 participants, 74.6% underwent surgery, while others who were considered unresectable were directed to chemoradiotherapy (CRT). The study, MDT-BRIDGE, was nonrandomized and had no comparison group.
How treatment changed after reassessment
Participants had previously untreated stage IIB to selected stage IIIB NSCLC, with EGFR and ALK wild type. At enrolment, local multidisciplinary teams classified 92 people (64.8%) as resectable and 50 (35.2%) as borderline resectable. The study used local team assessments rather than prespecified criteria to distinguish those categories.
Everyone received two cycles of durvalumab (1,500 mg) plus platinum-based chemotherapy, given every three weeks. After reassessment, those considered resectable could receive one or two additional cycles before surgery. Those considered unresectable were offered standard CRT, generally for about six weeks. After surgery or CRT, participants could receive durvalumab every four weeks for up to a year. This approach gave teams a planned point to redirect treatment if surgery was no longer considered suitable.
Local treatment was delivered to most participants
Overall, 106 of the 142 participants underwent surgery, giving a resection rate of 74.6% (95% confidence interval, 66.7–81.6). Among those who underwent surgery, 96.2% had an R0 resection, meaning no tumour was found at the surgical margins. Another 25 participants received CRT. In total, 131 participants (92.3%) received surgery or CRT after neoadjuvant treatment.
Among the 50 people classified as borderline resectable at the start, 31 (62.0%) underwent surgery and 43 (86.0%) received some form of local treatment—surgery or CRT. In the group considered resectable after reassessment, the pathological complete response rate was 27.3%, based on local pathology evaluation of the resected lung and lymph nodes.
The estimated 12-month event-free survival rate was 88.5%. That estimate is preliminary: at the analysis cutoff, 20 of 142 participants had experienced an event, and median follow-up among censored participants was 10.9 months. The primary endpoint, the overall resection rate, was descriptive and had no formal hypothesis test.
Of the participants who received durvalumab after local treatment, grade 3 or 4 adverse events occurred in 7.4% of the resected group and 17.4% of the CRT-treated group. Three participants had an adverse event leading to death: cardiac failure during consolidation treatment, interstitial lung disease, and one death not otherwise specified. The study reported the interstitial lung disease event as related to both treatment and surgery.
The findings provide early results for a strategy that links a surgery pathway with CRT for patients whose disease is judged unresectable after initial treatment. Because this was a single-arm study, borderline resectability was assessed locally without common protocol criteria, and survival follow-up was short, the results describe outcomes under this approach rather than a comparison of its relative benefit against another strategy.