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NSCLC: Consolidation Immunotherapy in Practice

Panelists:Walter Curran, JR., MD, FACR, Winship Cancer Institute of Emory University; Mark G. Kris, MD, Memorial Sloan Kettering Cancer Center; Jyoti D. Patel, MD, University of Chicago
Published: Tuesday, Apr 03, 2018



Transcript:

Mark Kris, MD: A lot of people have raised issues concerning the timing of durvalumab after the conclusion of chemotherapy/radiation. Are there any thoughts, that you’d like to raise, regarding this subject? It appeared that people who started it sooner may have had a slightly greater effect from the whole regimen.

Walter J. Curran Jr., MD: Yes. That’s very clear, and it’s a fairly dramatic difference. It’s not a randomized observation. It’s an observation that I think is going to influence practice, when possible. If people have recovered from the most serious acute effects of chemoradiation, I think the practice guidelines will look to starting it as soon as reasonable after chemoradiation. I also am seeing that in the design of future studies. If the PACIFIC trial data, for example, is the control arm of a study, they are looking to move that to as early as possible. There’s no evidence that suggests that toxicity is worse by doing that.

Mark Kris, MD: Inoperable, unresectable adenocarcinoma and squamous carcinoma—has it become a new standard for you, to give concurrent chemotherapy/radiation followed by durvalumab?

Jyoti D. Patel, MD: How could it not be a standard? With such a profound difference in progression-free survival, it has certainly been rapidly adopted at my center. We have started treating patients with it. Again, it’s an interim analysis, of course. I’m anxious about overall survival results. But with such a big difference, it’s going to be hard to really show a detriment.

Mark Kris, MD: Walter?

Walter J. Curran Jr., MD: I’d agree. Emphasizing that this is for good performance status patients who are able to get chemoradiation, this is, unquestionably, a new standard of care.

Mark Kris, MD: I’m more interested in the maturation of the progression-free survival curve. Only those people who are on the progression-free survival curve are going to be cured. I think that is the ultimate test, here. Are we really going to cure more patients? I’m really hoping that with more time, we’re going to see those progression-free survival curves mature. I do think it’s changed therapy, too. The other issue is, how many decades, Walter, have we been trying to do this? We’re, maybe, into the third decade of trying to do this. We’ve never succeeded. In fact, in multiple trials, harm was brought upon by our interventions. We were not trying to do that, but it happened. So, this is really helpful.

Walter J. Curran Jr., MD: Yes. When you look, the last positive trials were the sort of concurrent, first sequential trials.

Transcript Edited for Clarity 
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Transcript:

Mark Kris, MD: A lot of people have raised issues concerning the timing of durvalumab after the conclusion of chemotherapy/radiation. Are there any thoughts, that you’d like to raise, regarding this subject? It appeared that people who started it sooner may have had a slightly greater effect from the whole regimen.

Walter J. Curran Jr., MD: Yes. That’s very clear, and it’s a fairly dramatic difference. It’s not a randomized observation. It’s an observation that I think is going to influence practice, when possible. If people have recovered from the most serious acute effects of chemoradiation, I think the practice guidelines will look to starting it as soon as reasonable after chemoradiation. I also am seeing that in the design of future studies. If the PACIFIC trial data, for example, is the control arm of a study, they are looking to move that to as early as possible. There’s no evidence that suggests that toxicity is worse by doing that.

Mark Kris, MD: Inoperable, unresectable adenocarcinoma and squamous carcinoma—has it become a new standard for you, to give concurrent chemotherapy/radiation followed by durvalumab?

Jyoti D. Patel, MD: How could it not be a standard? With such a profound difference in progression-free survival, it has certainly been rapidly adopted at my center. We have started treating patients with it. Again, it’s an interim analysis, of course. I’m anxious about overall survival results. But with such a big difference, it’s going to be hard to really show a detriment.

Mark Kris, MD: Walter?

Walter J. Curran Jr., MD: I’d agree. Emphasizing that this is for good performance status patients who are able to get chemoradiation, this is, unquestionably, a new standard of care.

Mark Kris, MD: I’m more interested in the maturation of the progression-free survival curve. Only those people who are on the progression-free survival curve are going to be cured. I think that is the ultimate test, here. Are we really going to cure more patients? I’m really hoping that with more time, we’re going to see those progression-free survival curves mature. I do think it’s changed therapy, too. The other issue is, how many decades, Walter, have we been trying to do this? We’re, maybe, into the third decade of trying to do this. We’ve never succeeded. In fact, in multiple trials, harm was brought upon by our interventions. We were not trying to do that, but it happened. So, this is really helpful.

Walter J. Curran Jr., MD: Yes. When you look, the last positive trials were the sort of concurrent, first sequential trials.

Transcript Edited for Clarity 
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