Locally Advanced NSCLC: Next Steps in Research

Heather Wakelee, MD:Our patient, whom we’re discussing today, is a 64-year-old man with locally advanced non—small cell lung cancer whose treatment was different from what it would have been if he’d been diagnosed a year ago. The difference has to do with the results demonstrated by the PACIFIC study, showing that consolidation durvalumab after concurrent chemoradiation can significantly improve progression-free survival.

He had a diagnosis made with all the appropriate testing, additional tissue analyses, and discussion at multidisciplinary tumor board. Then he was treated with concurrent chemoradiation with weekly carboplatin/paclitaxel followed by consolidation durvalumab. That would not have been an option or something any one of us would have considered before the fall of 2017, and that was based on the significantly improved progression-free survival that was shown in PACIFIC with consolidation durvalumab.

So, that has really become the standard for patients with unresectable stage 3 lung cancer and will remain so into the future. But, of course, we want to keep moving ahead. And so, we are now asking some additional questions. Can we bring that in earlier? Now that we’ve shown that there’s better safety than we expected, can we bring the immune checkpoint inhibitors in concurrently with the radiation and the chemotherapy? Do we need to give a little bit of extra chemotherapy or not? These are the things that we’re still grappling with, that will be determined through the trials that will be coming out in the near future, most likely.

Transcript edited for clarity.

• A 64-year-old man presented with shortness of breath and persistent cough of 18 months’ duration; recently, he has experienced chest pain, fatigue, and blood in his sputum. After consulting with his primary care physician, he was referred for oncology evaluation
• Patient history includes
  • Current smoker (1/2 pack day)
  • Hypertension
  • Acute MI at age 60
• Evaluation and follow up testing reveal
  • Non-small cell lung cancer in left lung and 2 lymph nodes (Stage IIIa)
  • WHO performance status: 1
  • Histology: adenocarcinoma
  • EFGR, BRAF,andALK/ROS1mutation status: wild-type
  • PD-L1 status: ≥25%
• He underwent multidisciplinary evaluation and was not a candidate for surgery; he was treated with chemoradiotherapy:
  • Concurrent carboplatin-paclitaxel doublet chemotherapy and radiotherapy (60 Gy)
  • Achieved partial response
• He had no disease progression 20 days after his last radiotherapy treatment, and began treatment with durvalumab