From the Research
Immunotherapy with durvalumab typically begins 1-42 days after completion of concurrent chemoradiotherapy (CRT) for patients with unresectable stage III non-small cell lung cancer, with the optimal timing being within 14 days after completing CRT, as shown in the PACIFIC trial 1. The PACIFIC trial demonstrated that combining chemoradiotherapy with immunotherapy could improve clinical outcomes, and the timing of immunotherapy initiation is crucial for maximizing its effectiveness.
- The standard regimen consists of durvalumab 10 mg/kg administered intravenously every 2 weeks for up to 12 months.
- Starting immunotherapy soon after CRT is thought to be more effective because radiation may enhance tumor immunogenicity by increasing neoantigen presentation and promoting immunogenic cell death, creating a favorable environment for immunotherapy to work, as discussed in a review of tumor immunology and immunotherapy of non-small cell lung cancer 2. However, clinicians should ensure patients have recovered sufficiently from CRT-related toxicities before initiating durvalumab, with particular attention to pneumonitis, which could be exacerbated by immunotherapy, as highlighted in a study on immunotherapy in non-small cell lung cancer 3. Recent advances in immunotherapy have revolutionized the treatment of non-small cell lung cancer, and the introduction of immunotherapy in earlier stages, such as neoadjuvant treatment for potentially resectable tumors and in an adjuvant setting, has shown promising results, as discussed in a review of immunotherapy in non-small cell lung cancer 4. The combination of radiation and immunotherapy has also shown synergistic effects and may enhance survival, as reviewed in a study on radiation and immunotherapy combinations in non-small cell lung cancer 5.