Naiyer Rizvi, MD: Jacob, let’s say you have somebody on durvalumab and he progresses 9 months into it—what do you do? What's your treatment for metastatic disease?

Jacob Sands, MD: At that point, if this is someone with non-squamous progression, I think carbo/pem [carboplatin/pembrolizumab] is still a reasonable next-line option. Keep in mind that what they've gotten concurrent with radiation—none of those are really our classic metastatic regimens. So that being said, if someone is squamous and they have gotten carbo taxol [carboplatin taxol] that's weekly, 9 months out is a little further. But earlier than that, I'm not as excited about carbo taxol, even though they only get it weekly. But you could do another one of the squam [squamous] regimens. So you're looking at metastatic treatment and not really with a checkpoint inhibitor, because they’ve had progression on a checkpoint inhibitor.

Naiyer Rizvi, MD: Any other comments? What about if you progress 6 months after completing durvalumab? What's your regimen?

Jacob Sands, MD: Well, then I think 6 months you can consider using a checkpoint inhibitor again, and then I guess I would go into the metastatic pathways on that.

Joshua Bauml, MD: I think the key thing to emphasize here is this is a completely data-free zone.

Jacob Sands, MD: That's correct.

Joshua Bauml, MD: We have no idea what to do in this space, and research is absolutely essential because the PACIFIC trial [NCT02125461] really changed the landscape of how we treat locally advanced disease. I think that one thing, which has also changed the landscape, there are other trials in locally advanced. The NADIM study [NCT03838159] came out recently looking at neoadjuvant chemotherapy in stage III. There are lots of things that are changing the landscape in multiple different angles, and it's getting really difficult for these big trials to really know how to interpret them, but I think it's an exciting time to do this research, and a lot of advances are being made for our patients, which is great.

Transcript Edited for Clarity