Vol. 6 No. 4 (2026): April
Reimbursement Recommendations

Durvalumab (Imfinzi)

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Published April 22, 2026

Key Messages

  • Canada’s Drug Agency (CDA-AMC) recommends that Imfinzi in combination with fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy as neoadjuvant and adjuvant treatment, followed by adjuvant durvalumab monotherapy, be reimbursed by public drug plans for the treatment of adult patients with resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (stages II to IVA) if certain conditions are met.
  • The pan-Canadian Oncology Drug Review Expert Review Committee (pERC) determined that Imfinzi in combination with FLOT demonstrates acceptable clinical value compared with perioperative placebo in combination with FLOT in patients with resectable gastric or GEJ adenocarcinoma (stages II to IVA).
  • Evidence from a clinical trial (the MATTERHORN trial) showed that treatment with Imfinzi in combination with FLOT likely results in delayed disease recurrence or death compared with placebo plus FLOT. The results for the other secondary outcomes, including pathologic complete response rate and disease-free survival, further supported the findings. The safety profile of Imfinzi is considered generally predictable and manageable in adult patients with resectable gastric or GEJ adenocarcinoma. The comparative evidence of Imfinzi in combination with FLOT against other relevant therapies for GEJ cancer, particularly neoadjuvant chemoradiotherapy followed by adjuvant nivolumab, remains unknown.
  • Imfinzi in combination with FLOT should only be covered for the treatment of adults with documented stage II to IVA gastric or GEJ adenocarcinoma who have good performance status, are eligible for radical surgery, and have not received anticancer therapy for treatment of gastric or GEJ adenocarcinoma. Imfinzi in combination with FLOT should not be covered for patients with peritoneal dissemination or distant metastases, adenosquamous or squamous cell carcinoma, or uncontrolled autoimmune or inflammatory disorders.
  • Imfinzi in combination with FLOT should be initiated by clinicians with expertise and experience in treating gastric or GEJ adenocarcinoma. Following initiation, ongoing treatment can be delivered at a site closer to home.
  • Imfinzi in combination with FLOT should only be reimbursed if the cost of Imfinzi is reduced. Important budget impact considerations must be addressed for health systems to be able to adopt Imfinzi in combination with FLOT.