Dr. Gainor on the PACIFIC-2 Trial in Stage III NSCLC

Justin F. Gainor, MD, director of Targeted Immunotherapy, Massachusetts General Hospital, assistant professor of medicine, Harvard Medical School, discusses the phase III PACIFIC-2 trial in stage III non—small cell lung cancer (NSCLC).

With the PACIFIC-2 trial, investigators are trying to answer the question of whether concurrent delivery of immunotherapy is better than sequential delivery in patients with stage III unresectable NSCLC. In the trial, patients will be randomized to receive either platinum doublet chemotherapy plus radiation plus durvalumab (Imfinzi) followed by durvalumab consolidation or chemotherapy plus radiation followed by placebo consolidation.

Concurrent chemotherapy and radiation is better than sequential chemotherapy and radiation, says Gainor, but whether concurrent chemoradiation and immunotherapy is better than consolidative immunotherapy remains to be seen. The trial could go either way, he adds. Although it is known that radiation has profound effects on the immune system, the effects may be negated if both modalities are given at the same time. Notably, the control arm does not reflect the current standard of care, which will make it difficult to adapt to the current paradigm.