Dr. Kelly on the Benefit of Immunotherapy in Stage III NSCLC

Ronan J. Kelly, MD, MBA, chief of oncology for the ten Baylor Scott & White Health's North Texas Cancer Centers and director of oncology at the Baylor Charles A. Sammons Cancer Center on the campus of Baylor University Medical Center, discusses the benefit of immunotherapy in patients with stage III non—small cell lung cancer (NSCLC).

All of the patients who can receive definitive chemoradiation are potentially eligible for durvalumab (Imfinzi) if they don't have exclusion criteria for a PD-1 inhibitor, says Kelly. A caveat from the phase III PACIFIC trial pointed to the fact that patients with PD-L1 expression <1% on their tumor cells did not experience a benefit in overall survival (OS). There are many theories as to why that may be, but nothing has been confirmed yet. More research will be needed to determine why that is the case, he says.

Investigators are looking at specific subgroups of the PACIFIC trial because there were slight imbalances between arms, says Kelly. For example, in 1 arm, there were more females and more patients with adenocarcinoma; there was also an abnormal placebo performance. Investigators are looking at the data to understand it a little bit better, he says. Irrespective of these imbalances, there is no doubt that patients with a PD-L1 expression >1% experienced a significant benefit in progression-free survival and OS.