Immune-checkpoint inhibition in stage III unresectable NSCLC: Challenges and opportunities in the post-PACIFIC era

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 157; pp. 85 - 91
• Main Authors: Passiglia, Francesco, Leone, Gianmarco, Olmetto, Emanuela, Delcuratolo, Marco Donatello, Tabbò, Fabrizio, Reale, Maria Lucia, Bertaglia, Valentina, Consito, Lorena, Bironzo, Paolo, Capelletto, Enrica, Novello, Silvia
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-07-2021
• Subjects: Consolidation; Immune-checkpoint inhibitors; Non-small cell lung cancer; PD-1/PD-L1; Stage III; Stage III; Consolidation; PD-1/PD-L1; Non-small cell lung cancer; Immune-checkpoint inhibitors
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2021.05.009

•PACIFIC trial marked a new era in the treatment of stage III unresectable NSCLC.•Durvalumab consolidation following chemoradiation is the new standard of care worldwide.•Half of the patients receiving durvalumab consolidation are alive and one-third disease free at 4 years.•Intensified immunotherapeutic regimens and novel treatment combinations are under clinical investigation.•Effective therapeutic strategies in the post-durvalumab progression setting represent an unmet need for clinical research.
The PACIFIC trial marked a new era in the treatment of stage III unresectable NSCLC, establishing durvalumab consolidation as new standard of care worldwide, with about 14 % increase of long-term survival and half of the patients alive at 4 years. A series of intensified immune-checkpoint inhibition regimens are currently under investigation in clinical trials in order to optimize the therapeutic benefit obtained in this population, while the identification of personalized approaches as well as the development of effective treatments in the post-durvalumab progression setting represent an actual and controversial topic for clinical lung cancer research. This review describes the current real-word treatment scenario for stage III unresectable NSCLC in Italy, and provides an updated overview of the upcoming therapeutic strategies under clinical investigation, discussing the most relevant challenges and opportunities featuring the post-PACIFIC era.