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Care During Chemotherapy and Beyond

Durvalumab

(dur-VAL-ue-mab)

Trade Name(s): Imfinzi®

Durvalumab is the generic name for the trade name drug, Imfinzi. In some cases, health care professionals may use the trade name, Imfinzi, when referring to the generic drug name, durvalumab.

Drug Type: Durvalumab is an anti-cancer ("antineoplastic") drug. This medication is classified as an Anti-PD-L1 monoclonal antibody. (For more detail, see "How Durvalumab Works" below)

What Durvalumab Is Used For:

  • Durvalumab is used to treat urothelial cancers that are locally advanced or metastatic in patients who have disease progression during or following platinum containing chemotherapy or who have disease progression within 12 months of neo-adjuvant or adjuvant treatment with platinum containing chemotherapy.
  • Durvalumab is used for patients with unresectable stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Durvalumab Is Given

  • Durvalumab is administered as an IV once every two weeks.
  • The amount of durvalumab that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule.
  • You will be monitored for an infusion reaction which is a rare Occurrence.

Side Effects

Important things to remember about the side effects of durvalumab:

  • Most people will not experience all of the durvalumab side effects listed.
  • Side effects are often predictable in terms of their onset, duration, and severity.
  • Side effects are almost always reversible and will go away after therapy is complete.
  • Side effects may be quite manageable. There are many options to minimize or prevent side effects of durvalumab.

The following side effects are common (occurring in greater than 30%) for patients taking durvalumab:

These are less common side effects (occurring in 10-29%) for patients receiving durvalumab:

The following are rare but serious complications of durvalumab therapy triggered by an auto-immune reaction where the immune system goes after normal cells in the body. This can happen at any time while taking, and/or after stopping durvalumab. Contact your healthcare provider immediately if you have signs/symptoms of the following:

  • Pneumonitis (lung problems) identified by:
    • New or worsening cough
    • Shortness of breath
    • Chest pain
  • Hepatitis (liver problems) identified by:
    • Yellowing of your skin or the whites of your eyes
    • Severe nausea and vomiting
    • Pain on the right side of your stomach
    • Dark, tea colored urine
    • Bleeding or bruising more easily than normal
  • Colitis (intestinal problems) identified by:
    • Diarrhea
    • Blood in your stools or dark, tarry stool
    • Severe stomach pain or tenderness
  • Hormone gland problems (thyroid gland, adrenal gland, and pancreas) identified by:
    • Rapid heart beat
    • Increased sweating
    • Extreme tiredness
    • Unexpected weight gain or loss
    • Feeling more hungry or thirsty
    • High blood sugar
    • Hair loss
    • Irritability or forgetfulness
    • Constipation
    • Deepening of your voice
    • Low blood pressure
    • More frequent urination
    • Stomach pain
  • Kidney problems identified by:
    • Less frequent urination
    • Blood in your urine
    • Ankle swelling
    • Loss of appetite
  • Other organ problems:
    • Headache, change in balance, confusion
    • Severe muscle weakness or pain
    • Chest pain and tightness
    • Trouble breathing
    • Skin rash
    • Change in heartbeat
    • Flu like symptoms

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Doctor or Health Care Provider

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
  • Shortness of breath, cough
  • Confusion, imbalance

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24-hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in the urine
  • Pain or burning with urination
  • Extreme fatigue (unable to carry on self-care activities)
  • Yellowing of skin or eyes
  • Constipation unrelieved by laxatives use.

Always inform your health care provider if you experience any unusual symptoms.

Precautions

  • Before starting durvalumab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking durvalumab.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (Durvalumab may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking durvalumab, the medication must be stopped immediately and the woman given appropriate counseling.
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking durvalumab. Barrier methods of contraception, such as condoms, are recommended for up to 3 months after last dose of durvalumab.
  • Do not breast feed while taking durvalumab or for at least 3 months after last dose of durvalumab.

Self-Care Tips

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To reduce nausea, take anti-nausea medication as prescribed by your doctor, and eat small, frequent meals.
  • Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
  • Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Durvalumab

You will be checked regularly by your doctor while you are taking durvalumab to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC), glucose, as well as the function of other organs (such as your kidneys, liver, thyroid) will also be ordered by your doctor.

How Durvalumab Works

Monoclonal antibodies are a relatively new type of "targeted" cancer therapy.

Antibodies are an important part of the body's immune system. Normally, antibodies are produced by the body in response to an antigen, such as protein in a germ that the body recognizes as foreign. The antibodies attach to the antigen in order to mark it for destruction by the immune system.

To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells which act as the targets. Then, using animal and human protein, a specific antibody is created that will attach (like a lock and key) to the target antigen on the cancer cells.

Since monoclonal antibodies target only specific cells, they generally cause less toxicity to healthy cells. A limitation to monoclonal antibody use is that they can only be used for cancer in which antigens (and antibodies that bind them) have been identified.

Programmed death ligand 1 (PD-L1) is a specific protein (an immune check point protein) on tumor cells that binds to programmed death 1 (PD-1) on our body's anti-tumor t-cells which stops our body's t-cells from attacking the tumor cells. Durvalumab is a human immunoglobulin monoclonal antibody in a class called check point inhibitors. Durvalumab blocks PD-L1 on tumor cells from binding to PD-1 and CD80 on our t-cells. This allows for increased t-cell activation, which then frees up our antitumor t-cells and allows them to attack the cancer cells.

More research is needed to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Reference:

  • Durvalumab. Lexicomp Online® [updated 2017 November 22; cited 2018 January 12]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; January 12, 2018.

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