Dr. Hales on Investigational Treatment Strategies to Build Upon the PACIFIC Trial Results in Stage III NSCLC

Russell Kenneth Hales, MD, director, Thoracic Oncology Multidisciplinary Program, assistant professor of radiation oncology and molecular radiation sciences, Sidney Kimmel Cancer Center, Johns Hopkins Medicine, discusses investigational treatment strategies that have the potential to build upon the positive results of the phase 3 PACIFIC trial (NCT02125461) in stage III non–small cell lung cancer (NSCLC).

On February 16, 2018, the FDA approved durvalumab (Imfinzi) for the treatment of patients with unresectable stage III NSCLC whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy. Findings from the randomized PACIFIC trial, which led to the regulatory decision, demonstrated significant overall survival and progression-free survival improvement with durvalumab compared with placebo in this patient population.

These results changed practice for patients with stage III NSCLC; however, the field is continuing to develop novel therapies that could improve responses further, Hales explains. For example, many of these patients are over the age of 70 years, have a history of smoking, and have comorbidities, which makes tolerating concurrent chemoradiation difficult. Therefore, research strategies are evaluating the efficacy of consolidative immunotherapy following radiation therapy alone. Although this likely wouldn’t be the standard for patients with stage III NSCLC, it could be useful for patients who are not candidates for chemotherapy.

Another strategy includes incorporating immunotherapy with concurrent chemoradiation to synergize their effects, Hales says. Additionally, giving patients neoadjuvant immunotherapy prior to chemoradiation or adding an adjuvant therapy like a PARP inhibitor with immunotherapy following chemoradiation may be useful strategies as well, Hales concludes.