durvalumab: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
durvalumab: clinical details
Prescribing considerations
- Treatment should be initiated and supervised by a clinician experienced in cancer treatment.
- Confirm PD-L1 expression for the licensed locally advanced NSCLC indication and tumour MMR status for endometrial cancer.
- Review autoimmune disease, previous immune toxicity, transplantation, immunodeficiency, systemic immunosuppression, lung disease and active infection before treatment.
- Record the product name and batch number for biological traceability.
- Investigate suspected immune toxicity promptly, exclude alternative causes and withhold or discontinue treatment according to severity.
Contraindications and cautions
- Hypersensitivity to durvalumab or any excipient.
- Use caution where evidence is limited, including severe renal or hepatic impairment, significant autoimmune disease, immunodeficiency, transplantation or active tuberculosis, hepatitis or HIV infection.
Monitoring
- Assess for pulmonary, gastrointestinal, hepatic, endocrine, renal, cardiac, neurological, muscular, ocular, skin and infusion-related toxicity.
- Check liver tests before treatment and before subsequent infusions.
- Check thyroid and renal function before treatment and periodically thereafter.
- Monitor blood glucose or investigate promptly when symptoms suggest new-onset diabetes.
- Apply appropriate blood-count and infection monitoring when combined with chemotherapy or olaparib.
Clinical pharmacology
Durvalumab is a fully human IgG1-kappa antibody that blocks PD-L1 interactions with PD-1 and CD80 without inducing antibody-dependent cellular cytotoxicity. It is cleared mainly through protein catabolism and target-mediated disposition, so conventional metabolic interactions are not expected.
Formulation and product differences
- The product is a preservative-free, single-use concentrate requiring aseptic dilution for intravenous infusion.
- It may be diluted in sodium chloride or glucose infusion solution; it should not be shaken or mixed with other medicines in the same preparation.
- Discard the concentrate if it is cloudy, discoloured or visibly particulate.
durvalumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 50 mg/mL
durvalumab interactions
Formal pharmacokinetic interaction studies are limited, although metabolic interactions are not expected. Tell the oncology team about all prescribed, non-prescription and herbal products.
Systemic corticosteroids and other immunosuppressants
Use before starting durvalumab may reduce its immune activity. They may nevertheless be needed to control immune-related toxicity after treatment begins.
Live attenuated vaccines
Evidence around treatment is limited, so agree vaccination type and timing with the oncology team.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.