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

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 EGFR mutations derived the same benefit from the regimen as patients in the total population. Although patients with EGFR mutations were included in this trial, the subset was too small to draw conclusions from, says Vokes.