Durvalumab (Imfinzi): Uses, Cost and Side Effects

Durvalumab is not approved for cancer in general. It is approved in India for a defined list of settings, each cleared separately by the Central Drugs Standard Control Organisation. Within each one, only certain stages, prior treatments or biomarker results qualify.

The list has widened in steps rather than all at once. Durvalumab first entered Indian practice on the strength of the PACIFIC evidence in unresectable stage 3 non-small-cell lung cancer, and AstraZeneca Pharma India has since announced a series of CDSCO permissions to import and market the 120 mg/2.4 mL and 500 mg/10 mL vials for additional indications. Each addition is separate. A cancer type that is not on the list is not an off-label choice a patient can request.

Because that is where the evidence sits. In unresectable stage 3 non-small-cell lung cancer, chemotherapy and radiation given together is the curative-intent treatment. Durvalumab follows it as consolidation, aimed at disease the chemoradiation may have left behind. It does not replace either.

Consolidation is the word that confuses people most on this prescription. It means a course given after the main treatment has finished, in someone who has responded, to lower the chance of the cancer coming back. It is not a rescue treatment and it is not started because chemoradiation failed. If the restaging scan shows the disease has progressed, consolidation durvalumab is not the next step — the plan changes instead.

This sequence was established by the PACIFIC trial, and NCCN lists consolidation durvalumab as its Category 1 option after concurrent chemoradiation in this setting. It aims to reduce the chance of recurrence in a proportion of patients. It does not do so in everyone, and the trade-off is an added layer of immune-related risk on top of a chest that has just been irradiated.

1. Staging and multidisciplinary review — imaging and biopsy confirm stage 3 disease, and the team decides whether the tumour can be removed surgically. Durvalumab consolidation belongs to the unresectable path.
2. Concurrent chemoradiation — platinum-based chemotherapy and radiotherapy given together, usually over about six weeks. Why both are given at the same time is explained in concurrent chemoradiation: why both together.
3. Restaging scan and recovery review — the team confirms the disease has not progressed and that acute radiation effects, especially in the lungs, have settled enough to proceed.
4. Consolidation durvalumab begins — started as soon after chemoradiation as the label and the patient’s recovery allow, because delay is thought to matter in this setting.
5. Up to 12 months, or until it stops — treatment runs for a defined maximum in this indication, and stops earlier for progression, a serious immune-related event, or the patient’s decision.

If the prescription says durvalumab but no radiation has been given, the setting is a different one — small cell lung cancer, biliary tract, liver, bladder or endometrial disease each have their own approved combination and schedule. Ask which indication yours is; it changes the dose, the partner drugs and the duration.

Durvalumab comes in two vial strengths, 120 mg/2.4 mL and 500 mg/10 mL. Published Indian retail listings for the 500 mg vial sat at roughly ₹1.7–1.9 lakh when checked in August 2026. What you actually pay is set by dose, cycle count and the charges around each infusion.

Three things make a single vial price a poor guide to the total. Dosing is either 10 mg/kg every two weeks or a fixed 1,500 mg every four weeks for adults at or above 30 kg, so one four-weekly dose is usually made up from three 500 mg vials. Cycle count varies by indication — the stage 3 lung consolidation course runs up to 12 months. And the drug is only part of the bill: day care, nursing, pre-cycle blood tests and response-assessment imaging are charged separately.

Durvalumab is given as an intravenous infusion in a day-care oncology unit, typically over about an hour. Most people go home the same day. In the stage 3 lung consolidation setting the schedule is commonly a fixed 1,500 mg every four weeks, up to a maximum of 12 months.

It is not a tablet and it cannot be taken at home. Nothing about the infusion itself requires admission, sedation or hair loss — this drug does not cause the hair loss chemotherapy is associated with.

1. Before the cycle — blood tests check thyroid, liver, kidney and blood-count values, and you are asked about new symptoms since the last visit. A delayed cycle because of a blood result is routine, not a setback.
2. Review — the oncologist confirms the dose and that it is safe to proceed that day.
3. The infusion — a cannula is placed and the drug runs in, usually over about 60 minutes.
4. Short observation — a period of monitoring for infusion reactions before you leave.
5. Between cycles — you watch for new symptoms and report them promptly. Immune-related effects can appear weeks or months after a dose, and even after treatment has finished.

Duration depends on the indication. Stage 3 lung consolidation has a defined 12-month ceiling. In advanced-disease settings such as extensive-stage small cell, biliary tract or liver cancer, treatment usually continues while it appears to be working and is tolerated, reviewed at each scan. In every setting it stops earlier for progression, for a serious immune-related event, or because the patient chooses to stop — which is a legitimate choice, not a failure.

The characteristic risks are immune-related adverse events — the immune system inflaming a healthy organ. The commonest involve the thyroid, skin, gut, liver and lungs. Most are manageable when caught early. Inflammation of the lungs, bowel, heart muscle or adrenal glands is a medical emergency.

Lung inflammation deserves particular attention in the stage 3 lung setting. Radiation to the chest can itself cause pneumonitis, and drug-related pneumonitis can look identical. New breathlessness or a persistent dry cough after chemoradiation is never something to wait out at home on the assumption that it is "just the radiation" — it needs assessment, and the distinction matters because the treatments differ.

Immune-related events are defined as much by when they appear as by what they are. Skin rash and thyroid changes tend to show up earliest. Colitis, hepatitis and pneumonitis often appear later in a course, and some events surface weeks or months after the final dose. That is why pre-cycle blood tests continue throughout, and why any new symptom is worth mentioning even when it seems unrelated.

Symptoms that need urgent assessment, not home management: new or worsening breathlessness, or a persistent dry cough; loose motions that increase in number or contain blood; chest pain or palpitations; severe unexplained fatigue with dizziness, vomiting or collapse; yellowing of the eyes or skin. For any of these, contact your treating oncology team immediately or go to the nearest emergency department. Do not self-medicate and do not wait for the next scheduled cycle. Tell any doctor who sees you, in any department, that you are on immunotherapy — it changes how these symptoms are investigated.

Symptom-by-symptom guidance sits on the dedicated side-effect pages rather than here. This page is an orientation to the medicine, not a triage tool.

If the prescription itself is what is unclear — the molecule name, the dose, the schedule, what the abbreviations mean — start with Reading Your Prescription: What the Drug Name and Dose Mean. If the choice on the table is between this drug and the other one commonly discussed in stage 3 lung cancer, Durvalumab vs Pembrolizumab in Stage 3 Lung Cancer sets the two side by side.

For a lower-cost Indian monoclonal antibody used in a different setting and often confused with this class, see Nimotuzumab (BioMab EGFR): India’s Own Monoclonal Antibody. Where a CTLA-4 drug is added to a PD-1 or PD-L1 drug, Ipilimumab (Yervoy): Uses, Cost and Why It Is Combined explains the reasoning behind combining two checkpoint inhibitors.

For the wider view across checkpoint inhibitors, biosimilars and other medicine classes, start from Immunotherapy Medicines Explained, or from the main immunotherapy section. Since this drug follows radiotherapy in its dominant Indian use, the radiation side of the sequence is worth reading too — why chemotherapy and radiation are given together.