Clinical Approach for Unresectable Locally Advanced NSCLC - Episode 6
Jyoti Patel, MD:This patient illustrates, really, what I’ve started to do in my practice. For patients who are eligible for checkpoint blockade because they don’t have a history of autoimmune disease, they don’t have HIV, and they’re otherwise well, certainly, I am talking about this data to them and bringing it into the clinic already. Things that may have changed for me are chemotherapy backbone. So, cisplatin/etoposide has become a regimen that I have started using a little bit more, as well as cisplatin/pemetrexed over just weekly carboplatin/paclitaxel.
When I meet a patient, I say, “This is what the long strategy will look like,” and I think it can be overwhelming to hear that they may be on maintenance therapy or consolidation therapy for a year. So, we say, “We’ll finish chemotherapy and radiation.” Our plan is to do immunotherapy, but we will always reassess and do imaging and discuss quality of life and toxicity periodically.
We have struggled with locally advanced disease for decades, with modest improvements in certainly staging and supportive care but really no breakthroughs. The introduction of immune checkpoint blockade for our patientsparticularly durvalumab, as illustrated by the PACIFIC study—is a giant leap forward. Certainly, we’re seeing progression-free survival that we’ve seen in a clinical trial. And we await overall survival results, but at this juncture with the data that we have, this is a new standard of care for patients with locally advanced disease.
Transcript edited for clarity.