Dr. Hanna on Consolidation Immunotherapy in Stage III NSCLC

Nasser Hanna, MD, Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research, at Indiana University Melvin and Bren Simon Cancer Center, discusses the efficacy of consolidation immunotherapy in patients with stage III non—small cell lung cancer (NSCLC).

Prior to the phase III PACIFIC trial, the standard of care for this patient population had not changed for almost 2 decades, Hanna says. In February 2018, durvalumab (Imfinzi) became the first checkpoint inhibitor to gain FDA approval for the treatment of patients with unresectable NSCLC with the goal of reducing the risk of cancer progression. Durvalumab is indicated for patients whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.

In the PACIFIC trial, over 700 patients with inoperable stage III NSCLC were given chemotherapy and radiation and were then randomized 2:1 to receive adjuvant durvalumab every 2 weeks for 1 year or adjuvant placebo given intravenously every 2 weeks for 1 year. Patients who were treated with durvalumab had a median progression-free survival of 16.8 months versus 5.6 months for those who received placebo.

Prior to these data, Hanna says, it was long established that concurrent chemotherapy with radiation was the standard for patients with stage III NSCLC. For 20 years, trials evaluating induction immunotherapy, targeted agents, and other strategies were not successful at improving overall survival. The positive data from PACIFIC trial changed practice, establishing a new standard of care.