David Spigel, MD: There are ongoing trials in locally advanced lung cancer, both from the sponsor of PACIFIC, AstraZeneca, and other pharmaceutical biotech companies, looking at combinations with CTLA4 antibodies, administering checkpoint inhibitor therapy with radiation—not waiting for afterward, giving immunotherapies before chemoradiation therapy. A lot of these things are being examined in ongoing studies. I suspect the field will continue to evolve, but immunotherapy is here to stay in stage III cancer.
The other things that are on the horizon are obviously going to be other agents. But the idea that immunotherapy will find its way into resectable lung cancer, just as osimertinib is finding its way into resectable lung cancer. I think that could have implications for how you unresectable approach stage III cancer in the future. But for now, durvalumab is the standard of care. Other data look promising with pembrolizumab, and some early data we’ve seen from some combinations look promising. But nothing is certain in the United States.
Probably the 1 that keeps coming up has been largely around EGFR and PD-L1 testing, and we’ve spent some time discussing that. I don’t think it’s going to stay this way. There will be emerging data that teach us more about the role of immunotherapy in patients who don’t express PD-L1, patients who have EGFR...mutations. But I do believe that for patients who meet the criteria for enrollment on that study, which is pretty much everybody with unresectable stage III disease.
Transcript edited for clarity.