# Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer

Source: https://onco.cc/key-papers/paper-spigel-pacific-five-year-survival-jco-2022/  
OnCo record `paper-spigel-pacific-five-year-survival-jco-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Five years after the PACIFIC trial, 42.9 percent of patients given a year of immunotherapy after chemoradiotherapy were still alive, against 33.4 percent of those given placebo. A third of them had never relapsed.

## Summary

Spigel, Faivre-Finn, Gray and colleagues, with Antonia as senior author, reported the five-year update of PACIFIC, in which 713 patients with unresectable stage III non-small-cell lung cancer and no progression after concurrent chemoradiotherapy were randomised 2 to 1 to durvalumab 10 mg per kilogram every two weeks for twelve months or placebo, stratified by age, sex and smoking history. Data cutoff was 11 January 2021, with a median follow-up of 34.2 months across all patients and 61.6 months among censored patients.

Stage III lung cancer had been a plateau: chemoradiotherapy cured a minority and nothing added to it had helped for two decades. This is the update that turned a progression-free survival signal into a durable survival benefit, and it is the benchmark LAURA's osimertinib arm and the perioperative trials are set against.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: Journal of Clinical Oncology
- Year: 2022
- DOI: 10.1200/JCO.21.01308
- Authors: Spigel DR, Faivre-Finn C, Gray JE, et al.
- Findings: Estimated five-year overall survival 42.9 percent (95 percent confidence interval 38.2 to 47.4) with durvalumab against 33.4 percent (27.3 to 39.6) with placebo.; Estimated five-year progression-free survival 33.1 percent (28.0 to 38.2) against 19.0 percent (13.6 to 25.2).; Updated overall survival stratified hazard ratio 0.72 (0.59 to 0.89), median 47.5 against 29.1 months.; Updated progression-free survival stratified hazard ratio 0.55 (0.45 to 0.68), median 16.9 against 5.6 months.; 709 of 713 randomly assigned patients received durvalumab (473 of 476) or placebo (236 of 237).
- What it means: The current standard for unresectable stage III lung cancer, and the clearest evidence in the disease that consolidation immunotherapy converts responses into cures for some patients rather than merely delaying relapse.
- Caveats: Randomisation happened after chemoradiotherapy, so patients who progressed during it are not represented; the population is a selected, fitter one.; PD-L1-negative patients benefited less, and the European licence was restricted accordingly.; EGFR-mutant patients do poorly with checkpoint blockade here and are now treated with osimertinib instead (paper-lu-laura-osimertinib-stage-iii-nejm-2024).

## Sources

- J Clin Oncol 2022: https://doi.org/10.1200/JCO.21.01308
- PubMed: https://pubmed.ncbi.nlm.nih.gov/35108059/
- ClinicalTrials.gov NCT02125461: https://clinicaltrials.gov/study/NCT02125461

## Connected records

- key papers: [Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer](https://onco.cc/key-papers/paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024/), [Osimertinib after chemoradiotherapy in stage III EGFR-mutated NSCLC](https://onco.cc/key-papers/paper-lu-laura-osimertinib-stage-iii-nejm-2024/), [Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC](https://onco.cc/key-papers/paper-pacific-n-engl-j-med-2018-update/), [PACIFIC: a year of durvalumab after chemoradiotherapy for stage III lung cancer](https://onco.cc/key-papers/paper-pacific-nejm-2017/)
- 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/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Radiation Therapy](https://onco.cc/fronts/radiation/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Immune checkpoint](https://onco.cc/terms/immune-checkpoint/), [Radiotherapy](https://onco.cc/terms/radiotherapy/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- trials: [PACIFIC](https://onco.cc/trials/pacific/)
- people: [Martin Reck](https://onco.cc/people/martin-reck/), [Scott J. Antonia](https://onco.cc/people/scott-antonia/)
- bottlenecks: [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: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- 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/)

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