Read on Twitter
#OncoAlert Retrospective report @JTOonline on outcomes with chemoradiation plus durvalumab (PACIFIC) in patients with #EGFR mutant NSCLC. #LCSM https://www.jto.org/article/S1556-0864(21)01702-0/fulltext
Cohort of 37 patients with #EGFR mutant NSCLC: 13 received durvalumab consolidation and 24 did not (8/24 received TKI therapy). Only 2 patients completed 12 months of durvalumab, with most stopping for severe irAE or for disease progression. #LCSM
Retrospective analysis with built in confounders but chemoradiation alone had mPFS 6.9m, CRT + durvalumab mPFS 10.3m, CRT + EGFR TKI mPFS 26.1m. Stark differences but maybe not surprising - question is: which provides better OS and we need more data to answer that. #LCSM
I think most oncologists are uneasy for multiple reasons. Concern for poor IO efficacy in #EGFR coupled with toxicity if TKI needed later (indeed 1 patient had G4 pneumonitis after starting TKI post-durva). But do we deprive patients of survival benefit by withholding durvalumab?
An ongoing trial will provide some more data. The phase III LAURA trial explores the role of osimertinib in #EGFR mutant NSCLC after chemoradiation. But control arm is not durvalumab, control is CRT alone. And osimertinib treatment duration is indefinite. https://clinicaltrials.gov/ct2/show/NCT03521154
Thanks to authors for thoughtful report tackling a challenging scenario. @JoelNealMD @SukiPaddaMD @CarolineMccoach @DrJNaidoo @DrRaviSalgia @BLoo_LT_SABR @max_diehn @HwakeleeMD #LCSM @IASLC
