Everett E. Vokes, MD, John E. Ultmann Professor of Medicine and Radiation Oncology, physician-in-chief, chair, Department of Medicine, University of Chicago Medicine, discusses unanswered questions from the phase III PACIFIC trial in stage III non—small cell lung cancer (NSCLC).

Durvalumab (Imfinzi) has become standard of care for patients with unresectable stage III NSCLC who do not progress on concurrent chemoradiation based on the results of the PACIFIC trial. In the trial, patients who received chemoradiation followed by durvalumab experienced a significant improvement in progression-free survival and overall survival versus patients who received chemoradiation followed by placebo.

In a subset analysis, patients who received durvalumab within 2 weeks of completing concurrent chemoradiation appeared to derive additional benefit, explains Vokes. However, the patients who were able to start durvalumab in this timeframe may be fitter patients overall. Additional research is needed to determine whether starting durvalumab early is beneficial to patients.

Moreover, sequencing strategies need to be further explored as patients could benefit from receiving durvalumab in the neoadjuvant setting or concurrently with chemoradiation.  

Lastly, it is unknown whether patients with 

 mutations derived the same benefit from the regimen as patients in the total population. Although patients with 

 mutations were included in this trial, the subset was too small to draw conclusions from, says Vokes.

Videos

Everett E. Vokes, MD, discusses unanswered questions from the phase III PACIFIC trial in stage III non–small cell lung cancer. 

Dr. Vokes Discusses Unanswered Questions from the PACIFIC Trial in NSCLC

Everett E. Vokes, MD, Giant of Cancer Care: Head and Neck Cancer, chair, Department of Medicine, investigator of head and neck and lung cancer, University of Chicago, discusses a plenary session that covered prevention and screening at the 16th World Conference on Lung Cancer.

One talk, delivered by Christine Berg, MD, from Johns Hopkins University, emphasized the importance of screening. Berg provided an update on data that have shown that screening can reduce mortality by 20% among heavy smokers.

In the same session, David Christiani, MD, MPH, from the Harvard School of Public Health, gave a talk on the epidemiology of smoking. Though the population of smokers has decreased from about 50% to 17%, there are increasing socioeconomic concerns, Vokes says.

Finally, Graham Warren, MD, PhD, from the Medical University of South Carolina, presented on the clinical, biologic and behavioral considerations of smoking cessation among patients diagnosed with lung cancer. The question of whether or not it is important for patients to stop smoking was answered, Vokes says. There is suggestive evidence that continued smoking decreases the potential of curative therapy. Treatment should be pursued without further exposure to tobacco.

View more from the 2015 World Conference on Lung Cancer

Everett E. Vokes, MD, chair, Department of Medicine, investigator of head and neck and lung cancer, University of Chicago, discusses a plenary session that covered prevention and screening at the 16th World Conference on Lung Cancer.

Dr. Vokes on Screening, Epidemiology, and Smoking in Lung Cancer

Everett E. Vokes, MD, Giant of Cancer Care: Head and Neck Cancer, John E. Ultmann Professor Chair, Department of Medicine, Physician-in-Chief, University of Chicago Medicine and Biological Sciences, discusses the administration of PARP inhibitors as treatments for patients with lung cancer.

Â genesÂ have a detrimental impact on DNA repair. In many situations, these mutations are inherited; however, they can also be acquired, Vokes says.Â 

Further inhibition of the DNA repair mechanism through PARP inhibition results in antitumor activity.Â To accomplish this, PARP inhibitors are being examined in patients with lung cancer directly after a patient has received radiation. PARP inhibition is thought to augment the DNA damage already delivered by radiation, resulting in tumor cell death through a synthetic lethality, Vokes notes.

View more from the 15th Annual International Lung Cancer Congress

Everett E. Vokes, MD, Giant of Cancer Care: Lung Cancer, John E. Ultmann Professor Chair, Department of Medicine, Physician-in-Chief, University of Chicago Medicine and Biological Sciences, discusses PARP inhibitors as treatments for patients with lung cancer.

Dr. Vokes Discusses PARP Inhibitors in Lung Cancer

Everett E. Vokes, MD, Giant of Cancer Care in the Head and Neck Cancer Category, John E. Ultmann Professor of Medicine and Radiation Oncology, Physician-in-Chief, University of Chicago Medicine and Biological Sciences, discusses HPV-related head and neck cancer

As smoking rates in the U.S. have decreased, Vokes says, so has the number of cases of head and neck cancers associated with classic risk factors. However, there has been an emergence of HPV-driven tumors that are affecting the base of the tongue and the tonsils.

HPV is a sexually transmitted disease that affects males to females in a 3:1 ratio, Vokes says. The virus attacks the oropharynx and the base of the tongue.

Vokes says the patients with HPV receive similar treatment to patients with head and neck cancer induced by classic risk factors but the prognosis and cure rate of the patients with HPV are much higher. The oncology community has begun to question the need to be as aggressive in the treatment of HPV-related head and neck cancer.

Dr. Vokes on HPV-Related Head and Neck Cancer

Everett E. Vokes, MD, Giant of Cancer Care in the Head and Neck Cancer Category, John E. Ultmann Professor of Medicine and Radiation Oncology, Physician-in-Chief, University of Chicago Medicine and Biological Sciences, discusses multimodality therapy for patients with lung cancer.

At the 14th Annual International Lung Cancer Congress held from July 25-27, 2013, in Huntington Beach, CA, several sessions focused on the best way to administer multimodality therapy.

In the early staging work for a patient with lung cancer, surgeons and pulmonologists are very engaged. Typically, pulmonologists will help physicians to obtain a proper biopsy in tissue that is difficult to reach and guide a proper diagnosis. If the patient's tumor is particularly small, pulmonologists can help to treat tumors right away. Sometimes, a patient's physician will work with a radiation oncologist to administer a modern technique (stereotactic radiation) to avoid surgery.

Stereotactic radiation ablation is a very intensive form of radiation and has demonstrated increasingly exciting results. Though stereotactic radiation ablation is currently used to treat patients with inoperable states due to comorbidities or age, it may become the standard in other spaces as the administration is perfected.

Everett E. Vokes, MD, Giant of Cancer Care in Head and Neck from University of Chicago Medicine and Biological Sciences, discusses multimodality therapy for lung cancer.

Dr. Vokes on Multimodality Therapy for Lung Cancer

Everett E. Vokes, MD, John E. Ultmann Professor of Medicine and Radiation Oncology, Physician-in-Chief, Chair, Department of Medicine, University of Chicago Medical Center, discusses the use of cetuximab (Erbitux), an epidermal growth factor receptor (EGFR) inhibitor, for advanced head and neck cancer.

Vokes explains that an examination of the clinical data does not provide a clear picture of cetuximab’s efficacy. As a single agent it induces a response in 15-20% of patients, however, given the frequency of EGFR overexpression in head and neck cancer it could be assumed that this number should be higher.

The FDA recently approved cetuximab,in combination with chemotherapy, for advanced head and neck cancer patients. This trial added cetuximab to 5-fluorouracil and either cisplatin or carboplatin. The combination arm of the trial experienced a 2.7-month increase in survival over chemotherapy alone.

Vokes describes this trial as a breakthrough for these patients because it is the first of its kind to demonstrate an increase in survival.

Dr. Everett Vokes from University of Chicago Medical Center on Cetuximab for Head and Neck Cancer

Everett E. Vokes, MD

Articles

Dr. Vokes Discusses Unanswered Questions from the PACIFIC Trial in NSCLC

Dr. Vokes on Screening, Epidemiology, and Smoking in Lung Cancer

Dr. Vokes Discusses PARP Inhibitors in Lung Cancer

Dr. Vokes on HPV-Related Head and Neck Cancer

Dr. Vokes on Multimodality Therapy for Lung Cancer

Dr. Vokes on Cetuximab for Head and Neck Cancer