---
title: "Neoadjuvant durvalumab plus chemotherapy in resectable NSCLC: results from the phase 2 MDT-BRIDGE"
id: "nature-0-neoadjuvant-durvalumab-plus-chemotherapy-in-resectable-or-borderline-resectable"
canonical_url: "https://medichelpline.com/clinical-feed/nature-0-neoadjuvant-durvalumab-plus-chemotherapy-in-resectable-or-borderline-resectable"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "Nature Medicine"
source_url: "https://www.nature.com/articles/s41591-026-04742-7"
published_at: "2026-10-26T09:59:09.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Neoadjuvant durvalumab plus chemotherapy in resectable NSCLC: results from the phase 2 MDT-BRIDGE
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/nature-0-neoadjuvant-durvalumab-plus-chemotherapy-in-resectable-or-borderline-resectable
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** Nature Medicine
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41591-026-04742-7)
- **Published At:** 2026-10-26T09:59:09.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The MDT-BRIDGE trial tested perioperative **durvalumab** plus neoadjuvant platinum-based chemotherapy (AEGEAN regimen) in patients with resectable or borderline resectable **non-small-cell lung cancer** and used multidisciplinary team (MDT) assessments to guide treatment allocation. - Investigators predefined the primary endpoint as the overall resection rate; this was descriptive and not powered for formal hypothesis testing. - Secondary endpoints included event-free survival (EFS), progression-free survival (PFS), pathological complete response (pCR) in the resectable cohort, circulating tumor DNA (ctDNA) clearance between baseline and presurgery/pre-CRT, and safety outcomes. - A total of 142 patients received neoadjuvant treatment; baseline staging classified 64.8% as resectable and 35.2% as borderline resectable. - The overall resection rate was 74.6% (95% CI 66.7–81.6) in a study population that included over one-third borderline resectable cases; among those who underwent surgery, the R0 resection rate was 96.2% (90.6–99.0). - After neoadjuvant therapy, 131 patients (92.3%) received local curative-intent treatment: 106 underwent surgery and 25 received chemoradiotherapy (CRT); 117 patients (82.4%) subsequently received durvalumab as adjuvant (n = 94) or consolidation (n = 23) therapy. - During adjuvant or consolidation **durvalumab**, maximum grade 3–4 adverse events occurred in 7.4% of resected patients and 17.4% of CRT-treated patients; treatment discontinuation due to adverse events was 8.5% and 13.0%, respectively. - Investigators reported the MDT-guided approach was feasible, enabled delivery of curative-intent local therapy followed by durvalumab in most patients, and produced encouraging preliminary efficacy with a safety profile consistent with prior studies. - The report notes a broader context: across multiple phase 3 perioperative studies, roughly one in five patients deemed resectable at baseline do not proceed to surgery; in a US real-world cohort (REASON), 34.5% (167/484) did not undergo surgery after neoadjuvant chemoimmunotherapy. - The ClinicalTrials.gov identifier for MDT-BRIDGE is NCT05925530. The source did not report detailed dosing schedules or specific statistical testing plans beyond descriptive primary endpoint reporting.
## Clinical Analysis & Structured Key Points
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[articles](https://www.nature.com/nm/articles?type=article) 4. article Neoadjuvant durvalumab plus chemotherapy in resectable or borderline resectable non-small-cell lung cancer: the phase 2 MDT-BRIDGE trial [ Download PDF ](https://www.nature.com/articles/s41591-026-04742-7.pdf) [ Download PDF ](https://www.nature.com/articles/s41591-026-04742-7.pdf) * Article * [Open access](https://www.springernature.com/gp/open-science/about/the-fundamentals-of-open-access-and-open-research) * Published: 26 October 2026 # Neoadjuvant durvalumab plus chemotherapy in resectable or borderline resectable non-small-cell lung cancer: the phase 2 MDT-BRIDGE trial * [Martin Reck](https://www.nature.com/articles/s41591-026-04742-7#auth-Martin-Reck-Aff1) [ORCID: orcid.org/0000-0002-5348-4462](https://orcid.org/0000-0002-5348-4462)[1](https://www.nature.com/articles/s41591-026-04742-7#Aff1), * [Ernest Nadal](https://www.nature.com/articles/s41591-026-04742-7#auth-Ernest-Nadal-Aff2) [ORCID: orcid.org/0000-0002-9674-5554](https://orcid.org/0000-0002-9674-5554)[2](https://www.nature.com/articles/s41591-026-04742-7#Aff2), * [Carl M. Gay](https://www.nature.com/articles/s41591-026-04742-7#auth-Carl_M_-Gay-Aff3) [ORCID: orcid.org/0000-0002-4907-0718](https://orcid.org/0000-0002-4907-0718)[3](https://www.nature.com/articles/s41591-026-04742-7#Aff3), * [Nicolas Girard](https://www.nature.com/articles/s41591-026-04742-7#auth-Nicolas-Girard-Aff4)[4](https://www.nature.com/articles/s41591-026-04742-7#Aff4), * [Andrea Riccardo Filippi](https://www.nature.com/articles/s41591-026-04742-7#auth-Andrea_Riccardo-Filippi-Aff5-Aff6) [ORCID: orcid.org/0000-0001-7159-7869](https://orcid.org/0000-0001-7159-7869)[5](https://www.nature.com/articles/s41591-026-04742-7#Aff5),[6](https://www.nature.com/articles/s41591-026-04742-7#Aff6), * [Linda W. Martin](https://www.nature.com/articles/s41591-026-04742-7#auth-Linda_W_-Martin-Aff7) [ORCID: orcid.org/0000-0002-7951-5677](https://orcid.org/0000-0002-7951-5677)[7](https://www.nature.com/articles/s41591-026-04742-7#Aff7), * [Cordula Petersen](https://www.nature.com/articles/s41591-026-04742-7#auth-Cordula-Petersen-Aff8)[8](https://www.nature.com/articles/s41591-026-04742-7#Aff8), * [David A. Cairns](https://www.nature.com/articles/s41591-026-04742-7#auth-David_A_-Cairns-Aff9) [ORCID: orcid.org/0000-0002-2338-0179](https://orcid.org/0000-0002-2338-0179)[9](https://www.nature.com/articles/s41591-026-04742-7#Aff9), * [Margarita Majem](https://www.nature.com/articles/s41591-026-04742-7#auth-Margarita-Majem-Aff10) [ORCID: orcid.org/0000-0002-9919-7485](https://orcid.org/0000-0002-9919-7485)[10](https://www.nature.com/articles/s41591-026-04742-7#Aff10), * [Andrea Ardizzoni](https://www.nature.com/articles/s41591-026-04742-7#auth-Andrea-Ardizzoni-Aff11-Aff12)[11](https://www.nature.com/articles/s41591-026-04742-7#Aff11),[12](https://www.nature.com/articles/s41591-026-04742-7#Aff12), * [Rosa Alvarez Alvarez](https://www.nature.com/articles/s41591-026-04742-7#auth-Rosa_Alvarez-Alvarez-Aff13) [ORCID: orcid.org/0000-0003-0935-8298](https://orcid.org/0000-0003-0935-8298)[13](https://www.nature.com/articles/s41591-026-04742-7#Aff13), * [Andrew Robinson](https://www.nature.com/articles/s41591-026-04742-7#auth-Andrew-Robinson-Aff14)[14](https://www.nature.com/articles/s41591-026-04742-7#Aff14), * [Benoit Roch](https://www.nature.com/articles/s41591-026-04742-7#auth-Benoit-Roch-Aff15) [ORCID: orcid.org/0000-0002-4064-7621](https://orcid.org/0000-0002-4064-7621)[15](https://www.nature.com/articles/s41591-026-04742-7#Aff15), * [Arnaud Boyer](https://www.nature.com/articles/s41591-026-04742-7#auth-Arnaud-Boyer-Aff16)[16](https://www.nature.com/articles/s41591-026-04742-7#Aff16), * [Ilaria Attili](https://www.nature.com/articles/s41591-026-04742-7#auth-Ilaria-Attili-Aff17)[17](https://www.nature.com/articles/s41591-026-04742-7#Aff17), * [Maximilian Diehn](https://www.nature.com/articles/s41591-026-04742-7#auth-Maximilian-Diehn-Aff18) [ORCID: orcid.org/0000-0003-2032-0581](https://orcid.org/0000-0003-2032-0581)[18](https://www.nature.com/articles/s41591-026-04742-7#Aff18), * [David Kurtz](https://www.nature.com/articles/s41591-026-04742-7#auth-David-Kurtz-Aff19)[19](https://www.nature.com/articles/s41591-026-04742-7#Aff19), * [Ugochinyere A. Emeribe](https://www.nature.com/articles/s41591-026-04742-7#auth-Ugochinyere_A_-Emeribe-Aff20)[20](https://www.nature.com/articles/s41591-026-04742-7#Aff20), * [Ignacio Diaz Perez](https://www.nature.com/articles/s41591-026-04742-7#auth-Ignacio_Diaz-Perez-Aff21)[21](https://www.nature.com/articles/s41591-026-04742-7#Aff21), * [Matteo Giaj Levra](https://www.nature.com/articles/s41591-026-04742-7#auth-Matteo_Giaj-Levra-Aff21)[21](https://www.nature.com/articles/s41591-026-04742-7#Aff21), * [Davina Gale](https://www.nature.com/articles/s41591-026-04742-7#auth-Davina-Gale-Aff22)[22](https://www.nature.com/articles/s41591-026-04742-7#Aff22), * [Zhou Zhu](https://www.nature.com/articles/s41591-026-04742-7#auth-Zhou-Zhu-Aff21)[21](https://www.nature.com/articles/s41591-026-04742-7#Aff21), * [Nefeli Georgoulia](https://www.nature.com/articles/s41591-026-04742-7#auth-Nefeli-Georgoulia-Aff21)[21](https://www.nature.com/articles/s41591-026-04742-7#Aff21) & * … * [Jonathan Spicer](https://www.nature.com/articles/s41591-026-04742-7#auth-Jonathan-Spicer-Aff23) [ORCID: orcid.org/0000-0003-2708-1309](https://orcid.org/0000-0003-2708-1309)[23](https://www.nature.com/articles/s41591-026-04742-7#Aff23) Show authors [_Nature Medicine_](https://www.nature.com/nm) (2026) [Cite this article](https://www.nature.com/articles/s41591-026-04742-7#citeas) Save article [ View saved research ](https://www.nature.com/saved-research) ## Abstract The phase 2 MDT-BRIDGE study is investigating perioperative durvalumab plus neoadjuvant chemotherapy (AEGEAN regimen) in resectable and borderline resectable non-small-cell lung cancer and chemoradiotherapy (CRT) followed by consolidation durvalumab (PACIFIC regimen) in patients who become unresectable after neoadjuvant chemoimmunotherapy guided by multidisciplinary team assessments during the neoadjuvant period. The primary endpoint was the overall resection rate (descriptive with no formal hypothesis testing). Secondary endpoints included event-free survival, progression-free survival, pathological complete response rate (resectable patients cohort), circulating tumor DNA clearance between baseline and presurgery/pre-CRT and safety. Overall, 142 patients received neoadjuvant treatment; 64.8% and 35.2% were deemed resectable and borderline resectable at baseline, respectively. The overall resection rate (95% confidence interval) was 74.6% (66.7‒81.6) in a population that included more than one-third of patients with borderline resectable disease. R0 resection rate was 96.2% (90.6‒99.0) in those who underwent surgery. Overall, 131 (92.3%) patients had surgery (_n_ = 106) or CRT (_n_ = 25) after neoadjuvant treatment, and 117 (82.4%) patients received adjuvant (_n_ = 94) or consolidation (_n_ = 23) durvalumab. During adjuvant or consolidation durvalumab, maximum grade 3/4 adverse events occurred in 7.4% of resected patients and 17.4% of CRT-treated patients, with 8.5% and 13.0% discontinuing treatment due to adverse events. This multidisciplinary team-guided approach was feasible and enabled delivery of curative-intent treatment (surgery or CRT), followed by durvalumab in most patients, and demonstrated encouraging preliminary efficacy with a manageable adjuvant or consolidation safety profile that was consistent with prior studies. ClinicalTrials.gov identifier: [NCT05925530](https://clinicaltrials.gov/study/NCT05925530). ### Explore related subjects Discover the latest articles and news in related subjects. * [Cancer immunotherapy](https://www.nature.com/subjects/cancer-immunotherapy) * [Non-small-cell lung cancer](https://www.nature.com/subjects/non-small-cell-lung-cancer) * [Lung Cancer Diagnosis and Treatment Modalities](https://www.nature.com/subjects/lung-cancer-diagnosis-and-treatment-modalities) ## Main Immunotherapies targeting programmed cell death-1 (PD-1) or its ligand (PD-L1) have transformed treatment options for patients with resectable non-small-cell lung cancer (NSCLC), with multiple phase 3 studies demonstrating the benefit of chemoimmunotherapy in the perioperative setting[1](https://www.nature.com/articles/s41591-026-04742-7#ref-CR1 "Patel, A. et al. Neoadjuvant chemoimmunotherapy in non-small cell lung cancer: evolving resectability criteria, biomarker-driven postoperative management, and emerging therapeutic strategies. J. Immunother. Cancer 14, e014098 \(2026\)."),[2](https://www.nature.com/articles/s41591-026-04742-7#ref-CR2 "Heymach, J. V. et al. Perioperative durvalumab for resectable non-small-cell lung cancer. N. Engl. J. Med. 389, 1672–1684 \(2023\)."),[3](https://www.nature.com/articles/s41591-026-04742-7#ref-CR3 "Cascone, T. et al. Perioperative nivolumab in resectable lung cancer. N. Engl. J. Med. 390, 1756–1769 \(2024\)."),[4](https://www.nature.com/articles/s41591-026-04742-7#ref-CR4 "Forde, P. M. et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N. Engl. J. Med. 386, 1973–1985 \(2022\)."),[5](https://www.nature.com/articles/s41591-026-04742-7#ref-CR5 "Wakelee, H. et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N. Engl. J. Med. 389, 491–503 \(2023\)."). In AEGEAN ([NCT03800134](https://clinicaltrials.gov/ct2/show/NCT03800134?term=NCT03800134)), perioperative durvalumab plus neoadjuvant platinum-based chemotherapy, when compared with neoadjuvant chemotherapy alone, significantly improved the pathological complete response (pCR) rate and event-free survival (EFS) in patients with resectable stage IIA‒IIIB NSCLC[2](https://www.nature.com/articles/s41591-026-04742-7#ref-CR2 "Heymach, J. V. et al. Perioperative durvalumab for resectable non-small-cell lung cancer. N. Engl. J. Med. 389, 1672–1684 \(2023\)."). Similar outcomes were also reported in the KEYNOTE-671 study ([NCT03425643](https://clinicaltrials.gov/ct2/show/NCT03425643)) with perioperative pembrolizumab plus neoadjuvant chemotherapy in patients with resectable stage II‒IIIB NSCLC[5](https://www.nature.com/articles/s41591-026-04742-7#ref-CR5 "Wakelee, H. et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N. Engl. J. Med. 389, 491–503 \(2023\).") and in the CheckMate 816 ([NCT02998528](http://clinicaltrials.gov/ct2/show/NCT02998528)) and CheckMate 77T ([NCT04025879](http://clinicaltrials.gov/ct2/show/NCT04025879?term=NCT04025879)) studies with neoadjuvant or perioperative nivolumab plus neoadjuvant chemotherapy in patients with resectable stage IB‒IIIA NSCLC and resectable stage IIA‒IIIB NSCLC, respectively[3](https://www.nature.com/articles/s41591-026-04742-7#ref-CR3 "Cascone, T. et al. Perioperative nivolumab in resectable lung cancer. N. Engl. J. Med. 390, 1756–1769 \(2024\)."),[4](https://www.nature.com/articles/s41591-026-04742-7#ref-CR4 "Forde, P. M. et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N. Engl. J. Med. 386, 1973–1985 \(2022\)."). As a result, the standard of care for early-stage resectable NSCLC has evolved from initial surgery to neoadjuvant chemoimmunotherapy followed by surgical resection and adjuvant immunotherapy[6](https://www.nature.com/articles/s41591-026-04742-7#ref-CR6 "Lee, J. M. et al. Phase 3 trials of neoadjuvant, perioperative, and adjuvant chemoimmunotherapy for resectable, early-stage NSCLC: comprehensive review and detailed analysis. JTO Clin. Res. Rep. 6, 100866 \(2025\)."). However, a clinically relevant subgroup of patients deemed resectable at baseline do not ultimately receive surgery after neoadjuvant chemoimmunotherapy[4](https://www.nature.com/articles/s41591-026-04742-7#ref-CR4 "Forde, P. M. et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N. Engl. J. Med. 386, 1973–1985 \(2022\)."),[7](https://www.nature.com/articles/s41591-026-04742-7#ref-CR7 "Ricciuti, B. et al. Neoadjuvant PD-1 and PD-L1 blockade with chemotherapy for borderline resectable and unresectable stage III non-small cell lung cancer. JAMA Oncol. 11, 735–741 \(2025\)."). Across the phase 3 studies, approximately 20% of these patients did not proceed to surgery, most often due to disease progression, toxicity or a clinical decision[2](https://www.nature.com/articles/s41591-026-04742-7#ref-CR2 "Heymach, J. V. et al. Perioperative durvalumab for resectable non-small-cell lung cancer. N. Engl. J. Med. 389, 1672–1684 \(2023\)."),[3](https://www.nature.com/articles/s41591-026-04742-7#ref-CR3 "Cascone, T. et al. Perioperative nivolumab in resectable lung cancer. N. Engl. J. Med. 390, 1756–1769 \(2024\)."),[4](https://www.nature.com/articles/s41591-026-04742-7#ref-CR4 "Forde, P. M. et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N. Engl. J. Med. 386, 1973–1985 \(2022\)."),[5](https://www.nature.com/articles/s41591-026-04742-7#ref-CR5 "Wakelee, H. et al. Perioperative pembrolizumab for early-stage non-small-cell lung cancer. N. Engl. J. Med. 389, 491–503 \(2023\)."). Similarly, in the US real-world REASON study, 167 out of 484 (34.5%) patients with stage II‒III NSCLC treated with neoadjuvant nivolumab plus chemotherapy did not proceed to surgery[8](https://www.nature.com/articles/s41591-026-04742-7#ref-CR8 "Lee, J. M. et al. Real-world surgical and treatment patterns after neoadjuvant checkpoint inhibition in US patients with stage II/III non-small cell lung cancer. J. Clin. Oncol. 43, 8078 \(2025\)."). In the unresectable NSCLC setting, the phase 3 PACIFIC study ([NCT02125461](http://clinicaltrials.gov/ct2/show/NCT02125461)) demonstrated that consolidation durvalumab following concurrent chemoradiotherapy (CRT) significantly improved progression-free survival (PFS) and overall survival compared with placebo in patients with unresectable stage III NSCLC, with updated analyses demonstrating robust and sustained overall survival and durable PFS benefit at five years with durvalumab after CRT[9](https://www.nature.com/articles/s41591-026-04742-7#ref-CR9 "Antonia, S. J. et al. Durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. N. Engl. J. Med. 377, 1919–1929 \(2017\)."),[10](https://www.nature.com/articles/s41591-026-04742-7#ref-CR10 "Spigel, D. R. et al. Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer. J. Clin. Oncol. 40, 1301–1311 \(2022\)."). These findings established consolidation durvalumab after CRT as the standard of care in unresectable stage III NSCLC and redefined the treatment paradigm from CRT alone to an immunotherapy-integrated approach[11](https://www.nature.com/articles/s41591-026-04742-7#ref-CR11 "Zer, A. et al. Early and locally advanced non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol. 36, 1245–1262 \(2025\)."). However, evidence remains limited regarding the optimal management of patients with initially resectable disease who receive neoadjuvant chemoimmunotherapy but are subsequently unable to undergo surgery. In particular, it is unclear whether these patients can safely transition to definitive CRT and whether they derive benefit from the PACIFIC regimen following prior exposure to and lack of response to neoadjuvant immunotherapy. Despite established treatment paradigms for resectable and unresectable NSCLC, uncertainty remains for patients with borderline resectable disease. Definitions and criteria for resectability lack standardization and may vary according to disease characteristics and multidisciplinary assessment[12](https://www.nature.com/articles/s41591-026-04742-7#ref-CR12 "Dingemans, A. C. et al. Consensus definition of stage III non-small-cell lung cancer technical resectability to standardise inclusion criteria f
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