# PACIFIC: a year of durvalumab after chemoradiotherapy for stage III lung cancer

Source: https://onco.cc/key-papers/paper-pacific-nejm-2017/  
OnCo record `paper-pacific-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving the immunotherapy durvalumab for a year after chemoradiotherapy for unresectable stage III lung cancer tripled the time to progression and raised five-year survival from about a third to over 40%.

## Summary

Double-blind, placebo-controlled phase 3 trial of 713 patients with unresectable stage III NSCLC who had not progressed after concurrent platinum-based chemoradiotherapy, randomised 2:1 to up to 12 months of durvalumab or placebo. Co-primary endpoints were PFS and overall survival.

Median PFS was 16.8 vs 5.6 months (HR 0.52) and overall survival was significantly improved (HR 0.68 in the 2018 report). Five-year OS was 42.9% vs 33.4%. It was the first change in stage III standard of care in two decades and the model for consolidation immunotherapy in small-cell lung cancer (ADRIATIC) and other tumours.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1709937
- Authors: Antonia SJ, Villegas A, Daniel D, et al.
- Findings: Median PFS 16.8 vs 5.6 months; HR 0.52 (95% CI 0.42-0.65).; Overall survival (2018): HR 0.68; 24-month OS 66.3% vs 55.6%.; Five-year update (JCO 2022): OS 42.9% vs 33.4%; PFS 33.1% vs 19.0%.; Grade 3-4 pneumonitis or radiation pneumonitis 3.4% vs 2.6%; any-grade pneumonitis about 34% vs 25%.; Post hoc analysis suggested little benefit in PD-L1 below 1%, leading the EMA (but not FDA) to restrict the label to PD-L1 of 1% or more.
- What it means: Patients with stage III lung cancer that cannot be removed surgically should receive a year of durvalumab after completing chemoradiotherapy, provided they have not progressed. This roughly doubles the chance of being alive without progression at five years. Whether the benefit extends to PD-L1-negative tumours is contested, and the EGFR-mutated subgroup is better served by osimertinib (LAURA).
- Caveats: PD-L1 status was not required for enrolment and the subgroup analysis by PD-L1 below 1% was unplanned and post hoc.; Patients had to have completed chemoradiotherapy without progression, a selected fitter population.; Combined radiation and immune pneumonitis requires careful monitoring, especially in Asian populations where rates were higher.; The trial did not test whether concurrent immunotherapy during radiotherapy is better; PACIFIC-2 was negative.

## Sources

- NEJM 2017: https://doi.org/10.1056/NEJMoa1709937
- NEJM 2018 (OS): https://doi.org/10.1056/NEJMoa1809697
- ClinicalTrials.gov NCT02125461: https://clinicaltrials.gov/study/NCT02125461

## Connected records

- roadmaps: [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)
- key papers: [Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer](https://onco.cc/key-papers/paper-spigel-pacific-five-year-survival-jco-2022/), [Osimertinib after chemoradiotherapy in stage III EGFR-mutated NSCLC](https://onco.cc/key-papers/paper-lu-laura-osimertinib-stage-iii-nejm-2024/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Unresectable stage III non-small-cell lung cancer](https://onco.cc/cancers/stage-iii-unresectable-nsclc/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Platinum agents](https://onco.cc/technologies/platinum/)
- targets: [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Overall survival (OS)](https://onco.cc/terms/os/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/), [Standard of care](https://onco.cc/terms/standard-of-care/)
- people: [Byoung Chul Cho](https://onco.cc/people/cho-byoung-chul/), [Scott J. Antonia](https://onco.cc/people/scott-antonia/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- trials: [PACIFIC](https://onco.cc/trials/pacific/)

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