PublishedOctober 26, 2026
JournalNature Medicine
TrialMDT-BRIDGE (phase 2, single-arm, nonrandomized), NCT05925530

Multidisciplinary Team-Guided Durvalumab Plus Chemotherapy Achieves a 74.6% Resection Rate in Resectable and Borderline Resectable NSCLC, With Event-Free Survival Data Still Immature: The Phase 2 MDT-BRIDGE Trial

How this article was produced

How this article was produced

This article was written about a single named primary publication, with AI assistance for literature discovery, drafting and editing. AI tools are not the author and are not responsible for the conclusions.

How the draft was prepared

  • Discovery: PubMed is searched for oncology publications from the previous 14 days in a fixed list of major journals — JAMA Oncology, The Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Nature Reviews Clinical Oncology, New England Journal of Medicine, Nature Medicine, Cancer Discovery and Clinical Cancer Research — falling back to a named set of open-access journals only if that list yields nothing. Candidates are ranked by how completely they report quantitative results, and studies already covered are excluded.
  • Source: the article is drafted from the open full text in PubMed Central where one exists. Where only the abstract is available, it is supplemented with cited external sources — the trial registry record, conference abstracts, sponsor releases — and facts drawn from those sources are labelled as such.
  • Numbers are reported exactly as the source gives them, with confidence intervals and p-values, and are not rounded. Data the source does not report is stated as not specified rather than estimated.
  • Subgroup statistics are reported only where the source states them explicitly, and quotations are reproduced verbatim.
  • Benchmarks from other studies are labelled as cross-study comparisons and never presented as results of the trial itself.
  • Validation: every factual claim in the draft is checked against the source, and key claims are spot-checked against independent sources such as the trial registry. Fixable discrepancies are corrected before the draft is handed on for publication.

These steps are instructions followed by an AI system, not checks enforced by software. The validation step is itself performed by AI rather than a person, and its verdict does not by itself stop an article from being published. This describes the current workflow; some earlier articles predate parts of it.

Checks completed before publication

  • The primary publication is recorded in structured form — journal, publication date, DOI, PubMed ID and PMC ID where they exist — rather than only as prose in a reference list.
  • Every cited DOI is confirmed to resolve.
  • Every cited PubMed ID is confirmed to exist in PubMed.
  • The cited DOI is cross-checked against the DOI that PubMed records for that PubMed ID, so a citation cannot point at a different paper from the one the article describes.
  • Trial registry identifiers are format-checked and linked to their ClinicalTrials.gov record.
  • Every reference must carry a resolvable identifier or link, unless it is explicitly labelled as a funding note, press release or background statistic.
  • The article must contain a limitations discussion specific to the study — what it could not establish — not a generic disclaimer.
  • Absolutist claims such as “proves”, “guarantees”, “will cure” or “completely effective” are rejected.
  • HTML markup and entities that would render as literal text — such as an unsupported tag or " " — are rejected outside the reference list.
  • Structural checks confirm the article has a unique URL and complete metadata.

These run automatically on every article. If any of them fails, the build fails and the article is held rather than published.

What these checks do not cover

These checks confirm that the sources are real and correctly cited. They do not confirm that the analysis drawn from them is sound. This article has not been read against its primary source by a human editor, and should be read as a signpost to the primary publication rather than a substitute for it.

Evidence note

This article summarizes research findings and does not provide medical advice or treatment recommendations. Investigational findings, preliminary results, and preclinical evidence should not be interpreted as established clinical care. Always consult the cited primary source, and a qualified clinician, before acting on anything described here.

Corrections

Report a factual error or a sourcing concern through our corrections policy. Substantive corrections are dated and described on the article page. Our editorial policy explains how these articles are sourced, verified, and corrected.

Article Summary
  • MDT-BRIDGE is a global, single-arm, nonrandomized phase 2 trial in 142 patients with resectable or borderline resectable stage IIB–IIIB EGFR- and ALK-wild-type non-small-cell lung cancer. All received two cycles of neoadjuvant durvalumab plus platinum-based chemotherapy, after which a multidisciplinary team reassessed each patient and directed them to surgery or chemoradiotherapy, followed by durvalumab for up to 1 year. The overall resection rate, the primary endpoint, was 74.6% (95% CI, 66.7–81.6): 81.5% (95% CI, 72.1–88.9) in patients resectable at baseline and 62.0% (95% CI, 47.2–75.3) in those borderline resectable.
  • R0 resection was achieved in 96.2% (95% CI, 90.6–99.0) of patients who had surgery, and 92.3% of patients had surgery (n = 106) or chemoradiotherapy (n = 25) after neoadjuvant treatment. Twelve-month event-free survival was 88.5% (95% CI, 81.5–92.9) at 14.1% data maturity; overall survival was not reported. The trial had no comparator arm and no formal hypothesis testing.

Why This Study Matters

Perioperative chemoimmunotherapy has become standard for early-stage resectable NSCLC, yet the authors note that approximately 20% of patients across phase 3 studies did not proceed to surgery, most often because of disease progression, toxicity or a clinical decision. In the US real-world REASON study, 167 of 484 patients (34.5%) with stage II–III NSCLC treated with neoadjuvant nivolumab plus chemotherapy did not proceed to surgery. Resectability definitions also vary, particularly for borderline resectable stage III disease. MDT-BRIDGE asks whether structured multidisciplinary team (MDT) assessment, at baseline and again after two neoadjuvant cycles, can direct each patient to the most suitable curative-intent route.

1
Primary endpoint: overall resection rate 74.6% (95% CI, 66.7–81.6) in 142 patients; 81.5% (95% CI, 72.1–88.9) if resectable at baseline and 62.0% (95% CI, 47.2–75.3) if borderline resectable.
2
R0 resection: 96.2% (95% CI, 90.6–99.0) of those who underwent surgery.
3
Curative-intent treatment: 92.3% of patients had surgery (n = 106) or chemoradiotherapy (n = 25) after neoadjuvant treatment.
4
Pathologic and event-free outcomes: pCR 27.3% (95% CI, 19.6–36.1) in the resectable patients cohort (n = 121); 12-month EFS 88.5% (95% CI, 81.5–92.9) at 14.1% data maturity.

Study Design

MDT-BRIDGE is a global, nonrandomized, single-arm phase 2 study in patients with resectable and borderline resectable stage IIB–IIIB NSCLC confirmed as EGFR and ALK wild type. All patients received two cycles of neoadjuvant durvalumab plus platinum-based chemotherapy every 3 weeks, followed by MDT reassessment. Patients judged resectable received one to two further cycles and then surgery; those judged unresectable received standard-of-care chemoradiotherapy (CRT) for approximately 6 weeks. After surgery or CRT, all patients were to receive durvalumab every 4 weeks for up to 1 year (adjuvant after surgery, consolidation after CRT). The primary endpoint was the overall resection rate, descriptive with no formal hypothesis testing.

Trial at a glance

142 patients in the full analysis set (201 screened); 43 sites in 11 countries; single-arm, nonrandomized; median 3 neoadjuvant durvalumab cycles (range 2–4). Specific drug doses are not specified in the source passages summarized here.

Patient Population

Enrollment ran from 22 February 2024 to 2 July 2025. At baseline MDT assessment 92 patients (64.8%) were resectable and 50 (35.2%) borderline resectable. Median age was 67.0 years (range, 46–82); 65 (45.8%) were female; 129 (90.8%) were enrolled in Europe and 13 (9.2%) in North America; 88 (62.0%) had ECOG PS 0; 57 (40.1%) had squamous and 83 (58.5%) nonsquamous histology. Stage was IIB in 29 (20.4%), IIIA in 78 (54.9%) and IIIB in 34 (23.9%). Compared with the resectable cohort, more borderline resectable patients had stage IIIB disease and T4 primary tumors (T4: 25 of 50, 50.0%, vs 25 of 92, 27.2%).

Primary Endpoint: Resection Rate

This multidisciplinary team-guided approach was feasible and enabled delivery of curative-intent treatment (surgery or CRT), followed by durvalumab in most patients
— Reck et al., Nature Medicine 2026 (abstract)

Overall, 106 of 142 patients underwent resection (74.6%). After MDT reassessment, 120 patients were deemed resectable and 20 unresectable; two discontinued before reassessment. Of 120 patients considered resectable after reassessment, 14 ultimately did not undergo surgery. Of the 50 borderline resectable patients, 38 (76.0%) were reclassified as resectable after two cycles; 12 of 50 (24.0%) completed CRT and 43 of 50 (86.0%) ultimately received local therapy of any form.

Subgroup Analyses

All results below are descriptive; the study had no formal hypothesis testing and no comparator arm. The source reports no subgroup hazard ratios or p-values.

EndpointAll patientsResectable at baselineBorderline resectable at baseline
Resection rate (95% CI)74.6% (66.7–81.6)81.5% (72.1–88.9)62.0% (47.2–75.3)
R0 rate among resected (95% CI)96.2% (90.6–99.0), n = 10696.0% (88.8–99.2), n = 7596.8% (83.3–99.9), n = 31
pCR (95% CI)23.2% (16.6–31.1), FAS31.3% (21.6–42.4)18.4% (7.7–34.3)

Among 121 patients in the resectable patients cohort, 76 achieved an objective response (ORR 62.8%; 95% CI, 53.6–71.4); in the unresectable cohort, 4 of 21 (ORR 19.0%; 95% CI, 5.4–41.9). Among 25 CRT-treated patients, 84.0% had an objective response (n = 13) or stable disease (n = 8).

Event-Free and Progression-Free Survival

At 14.1% data maturity (20 of 142 events), 12-month EFS was 88.5% (95% CI, 81.5–92.9). In the resectable patients cohort it was 90.1% (95% CI, 82.8–94.4), rising to 92.9% (95% CI, 85.5–96.6) among those resected. 12-month PFS was 75.1% (95% CI, 45.2–90.2) in the unresectable patients cohort and 85.0% (95% CI, 59.8–95.0) in CRT-treated patients. Median follow-up in censored patients was 10.9 months (range, 1.0–20.2) for the primary EFS analysis. Overall survival was not reported owing to data maturity.

Exploratory ctDNA Clearance

In the 107-patient biomarker-evaluable population, 90 patients could be assessed for clearance from baseline to presurgery/pre-CRT; 33 of 90 (36.7%) cleared. Clearance was 40.6% (28 of 69) in patients deemed resectable versus 23.8% (5 of 21) in those deemed unresectable at reassessment. Among resected patients, 12-month EFS was 100.0% with ctDNA clearance (0 of 28 events) versus 88.9% (95% CI, 72.8–95.7; 5 of 40 events) without. These are small, descriptive subsets with few events.

Safety Profile

Period / cohortAny-grade AEsGrade 3/4 AEsOther
Postsurgery (n = 106)83.0%22.6%AEs possibly related to surgery 21.7%; imAEs 7.5%
CRT period (n = 25)88.0%28.0%Treatment-related AEs 64.0%; one imAE
Adjuvant, resected (n = 94)88.3%7.4%Discontinuation due to AEs 8.5%
Consolidation, CRT-treated (n = 23)82.6%17.4%Discontinuation due to AEs 13.0%

Across the whole study (N = 142), the most common any-grade AEs were anemia (36.6%), nausea (36.6%), asthenia (33.8%), constipation (28.9%) and diarrhea (26.8%); the most common grade 3/4 AEs were neutropenia (10.6%), anemia (4.9%), and diarrhea and fatigue (2.8% each). Three patients (2.1%) had an AE leading to death (cardiac failure, interstitial lung disease, and death not otherwise specified). Pneumonitis events occurred in 13 patients (9.2%). The authors conclude the safety profile was consistent with the established durvalumab profile and that no new safety signals were identified.

Interpretation and Broader Context

The authors interpret the findings as supporting a strategy that links the surgical (AEGEAN-like) and definitive CRT (PACIFIC-like) pathways under MDT guidance, with more than 92% of patients receiving curative-intent treatment. They note that comparison of the 12-month EFS of 88.5% with AEGEAN should be interpreted with caution because AEGEAN excluded patients requiring pneumonectomy and those with T4 invasion. They also state that ctDNA clearance (40.6% presurgery in resectable patients) was lower than reported in AEGEAN (66%) and CheckMate 77T (66%), likely reflecting differences in assay sensitivity. This report is not a treatment recommendation.

Limitations

The trial is single-arm and nonrandomized with no formal hypothesis testing, so it cannot show that MDT-guided treatment is better than any alternative strategy. EFS data are immature (14.1% maturity), follow-up is short, and overall survival is not yet reported. Baseline resectability was judged locally without predefined protocol criteria. The ctDNA and subgroup analyses are descriptive and rest on small subsets with few events. The study was funded by AstraZeneca, which participated in study design, data collection, analysis, interpretation and writing of the report.

Trial registration

Primary source: DOI 10.1038/s41591-026-04742-7 · PubMed 42934326

References

  1. Reck M, Nadal E, Gay CM, et al. Neoadjuvant durvalumab plus chemotherapy in resectable or borderline resectable non-small-cell lung cancer: the phase 2 MDT-BRIDGE trial. Nat Med. 2026. doi: 10.1038/s41591-026-04742-7. PMID: 42934326.
  2. ClinicalTrials.gov: NCT05925530 (MDT-BRIDGE). Sponsor/funder: AstraZeneca.