Imfinzi (Durvalumab): What It Is and What to Expect

This page is for people offered durvalumab (Imfinzi) and their families. It covers how it works, its approved uses, side effects, and when to get help.

Imfinzi is the brand name. Durvalumab is the generic name. It blocks PD-L1, a protein that tumors and nearby cells use to switch off T cells.

What sets durvalumab apart is where it sits in a plan. It can be used:

• Before surgery and after it
• After chemotherapy and radiation have finished, to hold ground already won
• With chemotherapy from the start, in some cancers

So the question is not only whether you are having it, but which job it is doing in your particular plan.

Non-small cell lung cancer

• With platinum chemotherapy before surgery and alone afterwards, for cancer that can be removed, when tumors are 4 cm or larger or lymph nodes are involved, and there is no EGFR or ALK change.
• Alone, for stage III cancer that cannot be removed and has not progressed after chemotherapy and radiation given together.
• With tremelimumab and platinum chemotherapy, for cancer that has spread, without a sensitizing EGFR or ALK change.

Small cell lung cancer

• Alone, for limited-stage disease that has not progressed after chemotherapy and radiation given together.
• With etoposide and either carboplatin or cisplatin, as first treatment for extensive-stage disease.

Other cancers

• With gemcitabine and cisplatin for biliary tract cancer.
• With tremelimumab for liver cancer that cannot be removed.
• With carboplatin and paclitaxel, then alone, for advanced or recurrent womb cancer that is mismatch repair deficient.
• With BCG for high-risk bladder cancer that has not invaded the muscle, in people who have not had BCG before.
• Around surgery for muscle-invasive bladder cancer, with gemcitabine and cisplatin first and durvalumab alone after the bladder is removed.
• With FLOT chemotherapy before and after surgery for stomach or gastroesophageal junction cancer.

Common side effects include tiredness, cough, breathlessness, rash and nausea.

The reaction that shapes the safety advice is different. Releasing the immune brake can let the immune system attack normal tissue. The label reports these reactions in the lungs, bowel, liver, hormone glands, kidneys, skin, nerves, heart and muscle. They can be severe and some have been fatal. They can start at any time during treatment. They can also start after treatment has ended.

Thyroid problems can happen. The label says to check thyroid function, liver enzymes and creatinine before treatment and from time to time during it. Signs of hormone gland problems on the FDA medication guide include extreme tiredness, weight gain or loss, feeling cold, headaches that will not go away, a rapid heartbeat, and dizziness or fainting.

Each dose runs into a vein over 60 minutes. The schedule and the amount depend on the cancer, the treatment plan and body weight. Your care team will give you your dates. The label lists infusion reactions, so tell your nurse right away if you have chills, shaking, itching, flushing, wheezing, dizziness or feel faint during the drip.

Because these reactions can start anywhere and at any time, a short written note beats memory. Write the date something starts, how bad it is, and whether it is getting worse. Bring it to appointments.

If you see another clinician, tell them you have had a checkpoint inhibitor, even if treatment finished months ago.

The FDA medication guide says to call or see your care team right away for any new or worsening sign of an immune reaction, even after treatment has ended.

• Call 911 or go to the nearest emergency department if breathing becomes hard work at rest, you have chest pain, or a severe headache arrives with blurred or double vision or weakness on one side. Go too if a rash starts to blister or the skin peels away, or if painful sores appear in your mouth, nose, throat or genital area. Do not drive yourself.
• Call 911 or go to the nearest emergency department if your stools are black and tarry, or you have sudden confusion or are hard to wake.
• Call your care team right away if a cough is new or worse, stools are loose, more frequent than usual or have blood or mucus, your eyes or skin turn yellow, your urine is dark, you have severe nausea or vomiting, or you feel extreme tiredness.
• Call your care team right away if you feel cold all the time, gain or lose weight without trying, have new joint pain or stiffness, or your muscles are weak or painful. If you still cannot reach your team, go to the nearest emergency department.
• If you are also on chemotherapy, call your care team right away, day or night, for a temperature of 100.4°F (38°C) or higher. CDC says to call your doctor right away and warns that an infection during chemotherapy can be life-threatening. If you cannot reach your team, go to the nearest emergency department and tell the staff you are having chemotherapy.
• If you are also on chemotherapy, call your care team right away, day or night, for chills, a sore throat, mouth sores, burning when you pass urine, or redness or swelling where a catheter enters your body. Do this even without a fever. A normal temperature is not a reason to wait.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8baba4ea-2855-42fa-9bd9-5a7548d4cec3

https://www.cancer.gov/about-cancer/treatment/drugs/durvalumab

https://www.cdc.gov/cancer-preventing-infections/patients/fever.html

https://www.cancer.gov/about-cancer/treatment/side-effects/infection