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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.
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.
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.
The biggest single advance in small-cell lung cancer since twice-daily radiotherapy in 1999, and the strongest argument that the disease responds to immunotherapy when it is given at a lower tumour burden.
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).
Shares Martin Reck, Immune checkpoint, 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, No one can predict who responds to immunotherapy and the tag lung-evidence.
Shares Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer, Radiotherapy, 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, Chemoradiation (chemoradiotherapy, CRT) and the tag lung-evidence.
Shares Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer, Immune checkpoint, 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, No one can predict who responds to immunotherapy and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, Surgery and radiotherapy cure most, get least and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, PD-L1 and the tag lung-evidence.
Shares Immune checkpoint, 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, No one can predict who responds to immunotherapy, PD-L1 and the tag lung-evidence.
Shares Radiotherapy, 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, Journal of Clinical Oncology, Lung cancer (all types) and the tag lung-evidence.
Shares Radiotherapy, 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, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.