Loading
Made a year of immunotherapy after chemoradiation the standard for stage III lung cancer, with a survival benefit that held at five years.
PACIFIC, trial NCT02125461 sponsored by AstraZeneca and reported in 2017, made a year of durvalumab after chemoradiation the standard for unresectable stage III non-small-cell lung cancer. It randomised 713 patients without progression after chemoradiation to durvalumab or placebo, met its primary progression-free survival endpoint by blinded review, and went on to show an overall survival benefit that held at five years, establishing consolidation immunotherapy as a concept. Its findings were reproduced in the real-world PACIFIC-R cohort and by GEMSTONE-301 with sugemalimab, and OnCo links it to Scott J. Antonia and to the chemoradiation and consolidation therapy terms. The benefit was weaker in EGFR-mutant disease, where LAURA now applies, and whether shorter or biomarker-guided consolidation could match a full year is the open question. Durvalumab has its own page.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
713 enrolled.
Step lines join published landmark estimates; the true curve between them is not shown.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival (BICR)primary | Durvalumab | 476 | 16.8 months | 0.52 (0.42 to 0.65) | <0.001 | link |
| Placebo | 237 | 5.6 months | ||||
| Overall survival at 5 yearsprimary | Durvalumab | - | 42.9% | 0.72 (0.59 to 0.89) | - | link |
| Placebo | - | 33.4% |
The current standard for unresectable stage III lung cancer, and the clearest evidence in the disease that consolidation immunotherapy converts responses into cures for some patients rather than merely delaying relapse.
A second publication from the PACIFIC trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
Patients with stage III lung cancer that cannot be removed surgically should receive a year of durvalumab after completing chemoradiotherapy, provided they have not progressed. This roughly doubles the chance of being alive without progression at five years. Whether the benefit extends to PD-L1-negative tumours is contested, and the EGFR-mutated subgroup is better served by osimertinib (LAURA).
Shares GEMSTONE-301, Unresectable stage III non-small-cell lung cancer, Durvalumab, AstraZeneca.
Shares Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer, PACIFIC: a year of durvalumab after chemoradiotherapy for stage III lung cancer, Unresectable stage III non-small-cell lung cancer, Chemoradiation (chemoradiotherapy, CRT).
Shares Unresectable stage III non-small-cell lung cancer, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Unresectable stage III non-small-cell lung cancer, Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Unresectable stage III non-small-cell lung cancer, Durvalumab, AstraZeneca, IMRT / IGRT (modern external beam).
Shares Unresectable stage III non-small-cell lung cancer, Durvalumab, IMRT / IGRT (modern external beam), Immune checkpoint inhibitors.
Shares Unresectable stage III non-small-cell lung cancer, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, AstraZeneca, Lung cancer (all types).
Shares Unresectable stage III non-small-cell lung cancer, Durvalumab, AstraZeneca, IMRT / IGRT (modern external beam).