Imfinzi (Durvalumab)

What Is Imfinzi (Durvalumab)?

Imfinzi (durvalumab) is an immunotherapy drug that boosts the body’s natural immune system. It combines two types of immunotherapy known to show promise in treating mesothelioma: checkpoint inhibitors and monoclonal antibodies.

Monoclonal antibodies are lab-made proteins designed to work like your body’s natural immune system proteins. Checkpoint inhibitors target proteins that normally help keep the immune system from attacking healthy cells. Some cancer cells, including mesothelioma, use these checkpoint proteins to hide from the immune system. Imfinzi blocks these checkpoint proteins, so the immune system stays active and can attack cancer cells more effectively.

Imfinzi is approved for bladder and lung cancer treatment. The FDA granted it Breakthrough Therapy Designation for non-small cell lung cancer. But the FDA hasn’t approved Imfinzi for treating mesothelioma. Researchers continue studying Imfinzi’s effectiveness in mesothelioma, and the immunotherapy drug is used only in clinical trials or occasionally off-label for this cancer.

How Does Imfizi (Durvalumab) Treat Mesothelioma?

Imfinzi targets PD-L1, a protein on cancer cells, to help fight them. Pleural mesothelioma cancer often produces high levels of this protein, making this mechanism especially important. 

Imfinzi blocks PD-L1’s “stop signal.” It’s designed to protect healthy cells, but cancer cells can exploit it to hide. Blocking this stop signal keeps immune cells alert so they can find and destroy cancer. Doctors sometimes test tumors for PD-L1 to better predict how people will respond to treatment. But benefits can happen without high levels.

Recent clinical trials, including the phase III DREAM3R study, combined Imfinzi with chemotherapy for pleural mesothelioma. Participants receiving both treatments showed better response rates and longer progression-free survival compared to chemo alone.

Imfinzi is often combined with another checkpoint inhibitor, Imjudo (tremelimumab), which blocks a different immune checkpoint protein called CTLA-4. Researchers are actively studying this combination in clinical trials to evaluate its effectiveness in treating mesothelioma.

Imfinzi for Asbestos-Related Lung Cancer

Imfinzi is approved for multiple types of lung cancer, many of which can be linked to asbestos exposure. It’s prescribed based on the specific type and stage of lung cancer, often in combination with other treatments.

FDA Approved Uses for Imfinzi 

• Adults with non-small cell lung cancer: Imfinzi is used for people whose disease hasn’t progressed after completing chemo and radiation therapy.
• Adults with extensive-stage small cell lung cancer: Imfinzi is given in combination with chemo drugs such as etoposide and either carboplatin or cisplatin as a first-line treatment.

The ADRIATIC trial tested durvalumab as an extra treatment for more than 500 people with limited-stage SCLC who finished chemo and radiation. People who got durvalumab stayed cancer-free longer and lived much longer than those who received a placebo. After 3 years, 57% of people treated with durvalumab were still alive, compared to 48% given the placebo.

Durvalumab helped the immune system find and kill leftover cancer cells after standard treatment. Two years into the trial, 46% of the durvalumab group showed no signs of cancer returning, versus 34% with placebo. Durvalumab also extended the average survival time from 33 months to 56 months.

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Durvalumab and Mesothelioma Clinical Trials

Durvalumab continues to show promise as a treatment for mesothelioma, especially when combined with chemo. Recent and ongoing clinical trials have shown encouraging results, pointing toward a potential shift in first-line therapy for this rare and aggressive cancer.

The DREAM3R trial is a large phase III study testing whether adding Imfinzi to standard chemo benefits people with advanced pleural mesothelioma. Results should come before February 2026. Another important study, the PrE0505 phase II trial, gave Imfinzi with platinum-pemetrexed chemo to people with untreated mesothelioma that can’t be removed with surgery. The study showed promising improvements in survival and response rates.

PrE0505 Phase II Trial Findings

• More than half of the participants (56.4%) saw their tumors shrink significantly.
• Survival rates were 87% at 6 months, 70% at 12 months and 44% at 2 years.
• On average, patients lived about 20 months. This is much longer than the usual 12 months with chemotherapy alone.
• Most side effects, like tiredness and nausea, were mild to moderate, including all immune-related side effects.

Dr. Patrick Forde, director of the thoracic cancer clinical research program at Johns Hopkins Kimmel Cancer Center, said of the trial, “The survival for patients with epithelioid MPM exceeded two years. And some patients with epithelioid MPM who enrolled in the clinical trial continue to be free from tumor progression today.”

The Dana-Farber Cancer Institute began a phase II trial in April 2017 of Imfinzi and Imjudo for people with mesothelioma who couldn’t undergo surgery. Navy veteran Jim McWhorter participated and told us he initially saw his cancer stay stable for several months. But after a CT scan showed new tumor growth, he said he had to leave the trial to seek other options.

Jim McWhorter

Verified Asbestos.com Survivor

Navy Veteran Pursues Mesothelioma Immunotherapy Trials

Jim was able to get into a clinical trial at Dana-Farber Cancer Institute in Boston, testing a combination of the immunotherapy drugs durvalumab and tremelimumab. For the first few months, the results were extremely positive. The cancer had stabilized.

Jim McWhorter

Verified Asbestos.com Survivor

Read Jim’s Story

Durvalumab Side Effects

Durvalumab side effects can range from mild to severe. In people taking Imfinzi for mesothelioma, the drug can stimulate the immune system, which may sometimes lead to mistakenly targeting healthy organs and tissues in addition to cancer cells.

Common Side Effects of Imfinzi

• Abdominal pain
• Bone and muscle pain
• Constipation
• Cough
• Diarrhea
• Fatigue
• Fever
• Loss of appetite
• Nausea
• Skin rash
• Swelling in arms or legs
• Urinary tract infection

Other mild side effects can include low sodium levels in the blood and a reduced white blood cell count. Most mild to moderate side effects of durvalumab can be managed with medications your doctor can prescribe.

Expert Take

Dr. Jacques Fontaine: Immunotherapy for Mesothelioma

View Transcript

Up until a few years ago, the only systemic therapy option for mesothelioma was chemotherapy, usually cisplatin and Pemetrexate, or carboplatin and Pemetrexate, also known as Alimta. As of a few years ago, we have found that immunotherapy, which is basically an injection, either underneath the skin or by the vein, which boosts the immune system to fight the cancer, is also an excellent choice in mesothelioma.


Immunotherapy has now been used not only just for mesothelioma, but in lung cancer, in esophagus cancer, kidney cancers, in skin cancers. So immunotherapy is a whole new category of cancer treatment. It’s the new age or the second generation of chemotherapy, immunotherapy.

Serious Side Effects of Imfinzi (Durvalumab)

Some signs of severe infusion reactions from Imfinzi include chills or shaking, fever, dizziness, wheezing, shortness of breath or lightheadedness. Flushing, itching or rash, facial swelling and back or neck pain can also occur.

Serious Imfinzi Side Effects

• Damage to hormone glands (thyroid, adrenals, pituitary and pancreas)
• Difficulty breathing
• Infections
• Inflammation in the lungs
• Inflammation of the colon lining
• Infusion-related reactions
• Kidney problems
• Liver disease
• Skin problems (rash, itching and blisters)

If you experience any mild or severe side effects while taking Imfinzi for mesothelioma, contact your doctor right away. Prompt medical attention can help manage side effects effectively and prevent them from becoming more serious.

Are All Mesothelioma Patients Eligible for Imfinzi (Durvalumab)?

People with mesothelioma may be eligible to join clinical trials of Imfinzi if their cancer has returned after prior treatment and their tumors have high levels of PD-L1. This protein is found in about 20% to 40% of pleural mesothelioma cases. Clinical trials usually require a confirmed diagnosis, disease progression after standard treatments and good overall health. 

In some cases, doctors may consider prescribing Imfinzi off-label for mesothelioma. This means using the drug outside its official FDA approvals based on the person’s condition and medical judgment. 

Another option for accessing Imfinzi is through compassionate use programs. Also called expanded access, this allows people with serious illnesses who can’t join clinical trials and have no other treatment options to receive experimental drugs. Access usually requires approval from the drug manufacturer and the person’s doctor. Sometimes approval from regulatory agencies is also required. Those interested in compassionate use should discuss it with their healthcare team or a Patient Advocate to explore eligibility and how to apply.

Common Questions About Imfinzi (Durvalumab) for Mesothelioma

How does durvalumab compare to other immunotherapies?

Studies suggest that when combined with chemo or other immunotherapies like tremelimumab, Imfinzi can offer survival benefits for mesothelioma similar to or better than other options. This includes the FDA-approved combination of Opdivo and Yervoy. Imfinzi is mostly available through clinical trials and isn’t yet FDA-approved for mesothelioma. You should discuss specific options, eligibility and clinical trial access with your mesothelioma specialist to determine the most suitable immunotherapy approach for you.

Can durvalumab be used if chemotherapy doesn’t work?

Yes, Imfinzi may be an option for some mesothelioma patients if chemo is no longer effective. You should consult your oncologist about available clinical trials and whether Imfinzi-based immunotherapy could be an option.

What can patients expect during Imfinzi treatment?

Mesothelioma patients receiving Imfinzi, usually as part of a clinical trial, can expect treatment with regular intravenous infusions, often every 3 weeks and sometimes combined with chemo. Patients will have frequent check-ups, scans and blood tests to track their response and monitor side effects.

Many people experience a period of stable disease or tumor shrinkage, but individual results vary. The length of treatment depends on the response to side effects. Ongoing communication with your health care team is important to manage potential complications.

How long can mesothelioma patients take Imfinzi?

Mesothelioma patients typically receive Imfinzi through IV infusions every 3 or 4 weeks, often in combination with chemo for 4 to 6 months. Maintenance doses follow if the cancer remains controlled. Most clinical trials limit the total duration to about 1 year, but the exact length of treatment depends on how well the person responds and tolerates any side effects.