Better Practice: Trimodality Treatment, 3x Improvement in Stage 3 Non Small Cell Lung Cancer (NSCLC)

Better Practice: Trimodality Treatment, 3x Improvement in Stage 3 Non Small Cell Lung Cancer (NSCLC)



Every year, there will be a certain treatment that will be the highlight of discussion and presentations in every oncology meetings/ events.

Last year, it was immunotherapy durvalumab, which delivered superior results for stage 3 non-small cell lung cancer (NSCLC);

  • adenocarcinoma and squamous
  • irrespective of EGFR status (wild type or mutant)
  • irrespective of PD-L1 status (no PD-L1 testing required)

Addition of durvalumab after concurrent chemo-radiotherapy treatment as adjuvant in stage 3 NSCLC prevent cancer from progressing for longer time.

Suitable patients must be:

  • Stage 3 lung cancer
  • Histology: non-small cell lung cancer (NSCLC) –  adenocarcinoma, squamous
  • Good performance status a.k.a able to walk about and perform daily activities independently
  • Complete concurrent chemotherapy and radiotherapy treatments
PACIFIC trial overview


  • On average, 3x longer duration without disease progression 16.8 months (trimodality) vs 5.6 months (chemotherapy and radiotherapy only).
  • At 18 months, no progression of cancer in 44% of patients on trimodality (vs 27% patients on chemotherapy and radiotherapy only).
PACIFIC trial: Significant improvement in progression free survival (PFS)

Important: This medication, which will likely cost above 100k, is currently available for free as it is awaiting registration and approval from regulatory authority.

[Programme ended. Treatment now cost around 150k for one year treatment; two weekly treatment x 26, with patient assistance program buy 1, free 1.]

The above result was undeniably good and the final result on overall survival will likely show improvement as well.

I hope more stage 3 patients will be able to have access to this effective treatment.


Update (post ESMO Munich 2018);

Further analysis of Pacific trial data noted that this treatment was:

  • Less effective/ no significant treatment with placebo in NSCLC patients with:
    • PD-L1 mutation < 1%
    • EGFR mutation positive 
  • More effective in NSCLC patients
    • Using cisplatin and etoposide concurrent chemotherapy
    • Initiating durvalumab treatment less than 14 days (when compared with > 14 days) after completion on concurrent chemo-radiotherapy.


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