Could you be a little more PACIFIC?

Interim results of the PACIFIC trial reported this week in the NEJM show that durvalumab (anti-PD-L1) given after chemoradiation for patients with Stage III non-small cell lung cancer (NSCLC) prolonged progression free survival by 11 months (16.8 vs 5.6 months with placebo). That’s...surprising to say the least, particularly when considering this was an unselected population without any particular baseline level of PD-1 expression. The authors hypothesized that chemoradiation upregulates PD-1 expression making a population more favorable for subsequent immunotherapy.  Another noteworthy outcome? Radiation pneumonitis wasn’t higher with the addition of durvalumab. Overall survival will be reported in the final analysis, but these are encouraging results both for patients with NSCLC as well as for durvalumab. Especially given its previous disappointing results in Stage IV NSCLC. Now we are left wondering who PACIFICally benefits from NSCLC treatment with durvalumab, pembrolizumab, or neither.