Dr. Spigel on the Rationale Behind the PACIFIC Trial

David Spigel, MD, chief scientific officer, director, Lung Cancer Research Program, principal investigator, Sarah Cannon Research Institute, discusses the rationale behind the design of PACIFIC, a trial that investigated the use of durvalumab (Imfinzi) in patients with locally advanced, unresectable stage III lung cancer.

The aim of PACIFIC was whether or not you could add immunotherapy to standard therapy. The idea of giving immunotherapy after chemotherapy and radiation therapy was most likely due to safety concerns. Immune-related toxicities, namely pneumonitis, can result from agents like durvalumab, and pneumonitis can be seen with chemotherapy and radiation.

The design of PACIFIC had as much to do with caution than a scientific theory that immunotherapy following chemoradiation is the best way to administer the treatment, says Spigel. Now that the study has been proven effective, many are wondering if antigen release results with chemotherapy and radiation, making tumors more vulnerable to T-cell activity.