Formal discussant of this trial, Michael Boyer, MBBS, PhD, a medical oncologist at Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Australia, was enthusiastic about these results, with the caveat that overall survival data are needed.
“Unresectable stage III non–small cell lung cancer (NSCLC) is an important subgroup of patients who are potentially curable, but the reality is that most of these patients are not cured. Five-year survival is about 15%. For at least a decade, attempts to improve survival with chemoradiotherapy have all failed,” Dr. Boyer told the audience. “Those of us who treat NSCLC have been banging our heads against the wall.”
“Therefore, it is relevant that the primary outcome of PACIFIC shows for the first time in a very long time a significant improvement in progression-free survival, about a 20% improvement at 12 and 24 months. We need to hear overall survival to truly evaluate the importance of these findings,” Dr. Boyer elaborated.
Patient Perspective Considered
“Dr. Hui’s presentation focused on patient-reported outcomes, which help us understand a different aspect of how our treatments work. We may feel that as physicians we can assess our patients’ experience, but an abundance of evidence suggests we often get it wrong. We want to determine that the gains in progression-free survival are not offset by a negative impact on quality of life,” he continued.
Dr. Boyer commended the investigators for a well-designed study using validated quality-of-life instruments. “The key findings are that there were no differences in global measures over time and no real difference in symptom improvement or deterioration, with a few minor exceptions that favor durvalumab [Imfinzi],” noted Dr. Boyer.
Despite some minor limitations of the study and a potential bias toward the control arm, Dr. Boyer called the improvement in progression-free survival “an important advance that occurred with associated deleterious effects in quality of life. This advance in NSCLC makes people who have been beating their heads against the wall believe there might be a bit of blue sky,” he stated. ■
DISCLOSURE: Dr. Boyer has received research support from Genentech/Roche, Pfizer, Eli Lilly, Merck Sharpe and Dohme, AstraZeneca, and Clovis.
The PACIFIC study showed that the addition of the programmed cell death ligand 1 (PD-L1) inhibitor durvalumab (Imfinzi) following chemoradiotherapy for patients with unresectable stage III non–small cell lung cancer (NSCLC) dramatically improved progression-free survival compared with placebo....