Dr. Weiss on the Design of the PACIFIC Trial

Jared Weiss, MD, associate professor, School of Medicine, UNC Chapel Hill, UNC Lineberger Comprehensive Cancer Center, discusses the clinical applications of the phase III PACIFIC trial in non—small cell lung cancer in the United States.

PACIFIC was a very real-world trial, says Weiss. There were no mandated PET scans to confirm stage, and there was no mandated radiation quality control. In the real world, many patients don’t get PET scans. Similarly, what is treated as stage III may be stage IV. Additionally, trial based quality controls are not looking over the shoulder of the radiation oncologist. The strength of PACIFIC is that it reflects a massive improvement at 18 months with the addition of durvalumab (Imfinzi).

In the United States, many physicians have access to PET scans and strict radiation quality controls. Many wonder if they can achieve the same benefit as in the trial, says Weiss. If some of the patients in PACIFIC really had stage IV disease and were randomized to an active drug versus an active placebo, they’re going to do better on the active drug. The same goes for inadequate radiotherapy. It’s a very similar critique that some of these patients were incurable due to the radiation quality.