Everett Vokes, MD
Approximately 30% to 40% of patients with non–small cell lung cancer (NSCLC) have stage III locally advanced disease at diagnosis.1,2
Stage III NSCLC is a highly heterogeneous disease that encompasses locally advanced primary tumors that have infiltrated mediastinal organs, involve mediastinal lymph nodes, or are larger than 7 cm.2,3
Patients are categorized as stage IIIA, IIIB, or IIIC, depending on tumor size and localization.3
, Everett E. Vokes, MD, moderated a panel of some of the world’s foremost experts on immunotherapy in lung cancer to discuss durvalumab and other emerging approaches for stage III NSCLC.
The Promise of Immunotherapy for Locally Advanced NSCLC
Immunotherapy has changed the paradigm for managing metastatic NSCLC. In took just a few years from the approval of checkpoint inhibitors as a second-line option to their integration into first-line management.
Roy S. Herbst, MD, PhD, suggested that immunotherapy is poised to make a real difference for this population. Rizvi agreed, saying that many patients would be affected.
The PACIFIC Trial
For PACIFIC, an ongoing phase III trial, investigators have enrolled approximately 700 patients with untreated, unresectable stage III NSCLC.4
Participants underwent standard chemoradiotherapy before being randomly assigned to durvalumab or placebo at a 2:1 ratio.4
Interim data presented at the ESMO 2017 Congress and simultaneously published in the New England Journal of Medicine
showed an approximately 11-month difference in median progression-free survival (PFS) that favored the durvalumab arm (16.8 vs 5.6 months; stratified HR for disease progression or death, 0.52; 95% CI, 0.42-0.65; P
Compared with placebo, durvalumab was also associated with a higher rate of 1-year PFS (55.9% vs 35.3%, respectively), 18-month PFS (44.2% vs 27.0%), and overall response (28.4% vs 16.0%; P
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