Dr. Patel on the Utility of Consolidative Durvalumab in Stage III NSCLC

Sandip P. Patel, MD, associate professor, University of California, San Diego (UCSD), co-leader, Experimental Therapeutics, deputy director, San Diego Center for Precision Immunotherapy, director, Clinical Trials Office, UCSD Moores Cancer Center, UCSD Health Sciences, discusses the utility of consolidative durvalumab (Imfinzi) in stage III non–small cell lung cancer (NSCLC).

The PACIFIC regimen, consisting of 1 year of durvalumab as consolidative therapy, is FDA approved for patients with unresectable stage III NSCLC whose disease has not progressed following concurrent platinum-based chemoradiation therapy. As nearly all patients respond to concurrent chemoradiation, the PACIFIC regimen has significant utility in this patient population, Patel explains. However, patients with underlying autoimmune conditions, such as idiopathic pulmonary fibrosis–related interstitial lung disease, may not be candidates for the PACIFIC regimen, Patel explains.

Notably, many patients who complete at least 1 month of concurrent chemoradiation develop toxicities, such as esophagitis, Patel says. However, data suggest that synergistic activity exists between immunotherapy and radiation therapy within 2 weeks after completion of chemoradiation. As such, starting patients on durvalumab approximately 2 weeks following chemoradiation completion could provide added benefit, Patel says.

Finally, in patients who receive weekly carboplatin plus paclitaxel, consolidative chemotherapy with 2 cycles of carboplatin plus paclitaxel every 3 weeks should not be given. Instead, patients should be started on consolidative durvalumab for 1 year, Patel concludes.