Evolving Treatment Landscape in Locally Advanced NSCLC

D. Ross Camidge, MD, PhD:In terms of what will happen in the stage 3 setting, pretty much everyone else with an immunotherapy drug is going to now chase down the results of PACIFIC. One of the things to look for is, is this going to be transferable across immunotherapy drugs? I think from the durvalumab perspective, can you build on that durvalumab, which is now the new standard of care? And so, for example, PACIFIC is durvalumab plus or minus an IDO inhibitor.

In terms of other things that may go on for stage 3 disease, people are going to explore immunotherapy combinations. This is going on in the advanced disease as much as it is in the locally advanced disease. The challenge there is, who do you combine and in whom and what biomarkers do you use? We haven’t quite figured out how to use PD-1 antagonists yet, so how we figure out who we give a combination to is going to be a huge challenge.

I think the other area that’s going to be interesting to explore is when you’ve had somebody who has had trimodality therapy—so chemotherapy, radiotherapy, induction, and then resection. Do these data apply? Do we have to wait for the data to come from an adjuvant, just simple resection study? It’s all to play for.

In terms of whether this will have a role in the patients with operable disease, I think there are 2 approaches that are being explored. So, one is the obvious that you’ve had resection, you go through adjuvant chemotherapy or don’t go through that. And then the role of immunotherapy there, I think those studies are ongoing. They’ll read out. I think PACIFIC suggests that maybe they are going to be encouraging and we’ll get some kind of bridging process going on in our minds between PACIFIC and those studies, for example, those people who go through trimodality therapy.

The other thing that people are looking at is induction therapy with PD-1 antagonists. Very small study. It has shown a remarkably high pathologic response rate, and I think that may also be something that people will go for in the future. So, I think people are trying every possible combination. We’ll have to wait and see.

Transcript edited for clarity.