Durvalumab

Mechanism of action

◆Programmed death-ligand 1 (PD-L1) on tumour and immune cellsDurvalumab

ⓘ The crystal shows the extracellular domain of human PD-L1 bound to the durvalumab Fab, which covers the face PD-L1 uses to bind PD-1.

Many tumours display PD-L1, which binds PD-1 on T cells and switches them off. Durvalumab is a human IgG1 antibody that binds PD-L1 and blocks this contact, so cytotoxic T cells that reach the tumour stay active and can kill cancer cells. Because the same brake also protects healthy tissues, releasing it can let T cells attack normal organs.

1. Durvalumab binds PD-L1 on tumour cells
2. PD-L1 can no longer switch off T cells through PD-1
3. T cells attack the tumour, and sometimes healthy organs

Indications

• Non-small cell lung cancer: unresectable stage III after chemoradiation, around surgery, or metastatic with tremelimumab and chemotherapy (without EGFR or ALK changes). Lung cancer →
• Small cell lung cancer: limited stage after chemoradiation, or extensive stage first line with etoposide and a platinum drug. Lung cancer →
• Spread biliary tract cancer (cholangiocarcinoma, gallbladder cancer) with gemcitabine and cisplatin. Cholangiocarcinoma (bile duct cancer) →
• Unresectable hepatocellular carcinoma, with tremelimumab. Hepatocellular carcinoma →
• Muscle-invasive bladder cancer around surgery; mismatch repair-deficient endometrial cancer; resectable gastric or gastro-oesophageal junction cancer, with chemotherapy. Bladder cancer →

Adverse effects

Common

• Tiredness, cough, shortness of breath
• Constipation, decreased appetite
• Swelling of the arms or legs
• Muscle or bone pain, trouble sleeping, hair loss

Contraindications

• No absolute contraindications in the label apart from hypersensitivity; see the warnings

Key interactions

Corticosteroids and other immunosuppressants

May be needed to treat immune side effects; the team decides when to use them.

What is monitored

• Thyroid, liver and kidney tests and blood glucose before and during treatment
• New cough or breathlessness (pneumonitis)
• Stools: number, blood, abdominal pain
• Vital signs during and shortly after the infusion

Administration and safety

• Intravenous infusion by a doctor or nurse in a hospital or clinic; the patient is watched during and shortly after it.
• The infusion may be paused or stopped for a reaction, and treatment may be held for immune side effects.
• The patient receives the Medication Guide to read.

Pregnancy and breastfeeding

Avoid in pregnancy. Can harm the fetus; a pregnancy test may be done before starting, contraception is used during treatment and for months after, and breastfeeding is avoided.

Nursing care

• Ask about transplants (including cornea and stem cells), autoimmune disease and chest radiotherapy before starting.
• Teach that immune side effects can appear at any time, even after treatment ends, and must be reported early.
• Teach to report cough, diarrhoea, yellow skin, unusual headaches, thirst, dizziness, palpitations, muscle weakness or rash.
• Watch for chills, flushing, wheeze or back pain during the infusion.

Pharmacokinetics

Absorption

Intravenous infusion over about an hour, every few weeks.

Elimination

Broken down like other IgG antibodies, by protein catabolism.

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Connections

← Back to the class: Immune checkpoint inhibitors

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Durvalumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Durvalumab - NCI (National Cancer Institute (U.S.), 2026); PD-L1 in complex with durvalumab (RCSB Protein Data Bank, 2017).

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Representative model, for educational purposes only.