Impact of PACIFIC Trial on Locally Advanced NSCLC

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Mark A. Socinski, MD: Hello and thank you for joining us today. Immune therapeutic targets, combinations, and approaches to sequencing have resulted in wide-scale change throughout thoracic oncology. Clinical trials in lung cancer continue to read out and help us to improve outcomes for our patients. In this OncLive Peer Exchange® discussion, “Emerging Treatment Paradigms for Advanced Lung Cancer,” I’m joined by a panel of experts in lung cancer management. Today we will discuss the ever-changing treatment landscapes of advanced lung cancer in 2019.

I am Dr Mark Socinski, executive medical director of the Advent Health Cancer Institute and member of the Thoracic Oncology Program in Orlando, Florida.

Participating today on our distinguished panel are:

Dr John Heymach, professor and chairman of the Department of Thoracic and Head and Neck Medical Oncology at the MD Anderson Cancer Center in Houston, Texas.

Dr Leora Horn, associate professor of medicine at Vanderbilt University Medical School in Nashville, Tennessee.

Dr Mohammad Jahanzeb, professor of clinical medicine and medical director of Sylvester Deerfield Campus at the University of Miami, Miller School of Medicine, in Miami, Florida.

Dr Heather Wakelee, professor of medicine at Stanford University in Stanford, California.

And Dr Jarushka Naidoo, assistant professor of oncology and attending physician at the Sidney Kimmel Cancer Center at Johns Hopkins University in Baltimore, Maryland.

Colleagues, I look forward to a great discussion today so let’s begin.

One of the things that’s changed dramatically over the past 6 to 12 months, after a long drought in stage III disease, where we had established that concurrent chemoradiotherapy was the standard platform, we had the results of the PACIFIC trial, which have really changed the standard of care in stage III disease. And I’m wondering MJ if you could walk us through the top-line results of the PACIFIC Trial.

Mohammad Jahanzeb, MD: Sure, I would love to. I think knowing that PACIFIC is the largest ocean, it’s fitting that this is the largest advance we have made in stage III inoperable non—small cell lung cancer [NSCLC]. The trial was actually a placebo-controlled trial of durvalumab delivered every 2 weeks in a group of patients who had inoperable stage III disease and had completed standard chemoradiotherapy. More than 700 patients were randomized in a 2-to-1 manner, twice as likely to receive durvalumab. And they actually could start within 6 weeks—42 days—of finishing radiation. And the results actually had to have 2 coprimary endpoints, both progression-free survival [PFS] as assessed by a blinded panel, and overall survival. And at the end of evaluation, which is not super final for survival, but for PFS we have it, that it was 5.3 months I believe in the arm that got placebo. And about 16 months in the arm that got durvalumab. So it tripled.

Now one could say that 5 months is very short and historically we are thinking of 11-, 13-, 17-month type of figures, but one has to take into account that these patients started after finishing their treatment with chemoradiotherapy, and another 4-to-6-week gap, even though they could start the day after, but generally nobody really started the day after. So when you take that into account, control arm is not as bad as we think, and it’s believable, so I think this is a real advance.

Mark A. Socinski, MD: Yes. At the end of the day the median survival on the control arm was approximately 28 months, which is pretty good for any standard from a control point of view, and median survival has not yet been reached on the durvalumab arm.

Mohammad Jahanzeb, MD: Yes. And the only other thing to point out is that retrospectively done PD-L1 [programmed cell death protein 1] analysis, and not on the whole group of patients, appeared to not show benefit in those who were PD-L0. But since it’s a post-hoc retrospective partial analysis, and the trial wasn’t powered to look at that, I don’t think one should make much of that.

Transcript Edited for Clarity