Applicability of the PACIFIC trial results in patients not eligible for the PACIFIC trial: Canadian rapid consensus statement and recommendations.

Robinson, Dr.Andrew G.; Snow, Stephanie; Brade, Anthony; Ho, Cheryl; Wheatley‐Price, Paul; Blais, Normand; Cheema, Parneet K.; Swaminath, Anand

doi:10.1016/j.ctarc.2020.100265

Cited by 3 publications

(5 citation statements)

References 53 publications

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“…70 To date, optimal treatment of stage III (inoperable) LCNEC disease is unclear, chemoradiotherapy with or without prophylactic cranial irradiation may be given, and the role of durvalumab is debated. 73 In stage IV disease, OS of LCNEC is similar to SCLC. 5 Yet, LCNEC seems to be less chemotherapy sensitive compared with SCLC, and different chemotherapy treatment schedules for LCNEC have been proposed.…”

Section: Q3 What Is the Value Of A Typical Or Atypical Carcinoid Diagnosis On A Biopsy Specimen In Local And Metastatic Disease?mentioning

confidence: 99%

“…From a clinical perspective, it is important to separate locally advanced and metastatic NSCLC from LCNEC as (1) the treatment effect of durvalumab and pembrolizumab is unclear, (2) NSCLC more often has driver mutations compared with LCNEC, (3) NSCLC has a better prognosis, and (4) NSCLC and LCNEC have different systemic treatment strategies (i.e., pemetrexed may not be suitable whereas etoposide maybe more suitable for LCNEC). 37,73,76,106 When making a diagnosis, neuroendocrine morphology is key to distinguish LCNEC from NSCLC in tumors with abundant cytoplasm and conspicuous nucleoli, as both tumors can express TTF-1 at a high frequency. 1 Neuroendocrine morphology is a suitable criterion for diagnosis on surgical resection specimens but not for biopsy specimens, causing under-recognition of LCNEC as NSCLC in up to 50%, as highlighted previously.…”

Section: Recommendedmentioning

confidence: 99%

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Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice

Derks¹,

Rijnsburger²,

Hermans³

et al. 2021

Journal of Thoracic Oncology

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Diagnosing a pulmonary neuroendocrine neoplasm (NEN) may be difficult, challenging clinical decision making. In this review, the following key clinical and pathologic issues and informative molecular markers are being discussed: (1) What is the preferred outcome parameter for curatively resected low-grade NENs (carcinoid), for example, overall survival or recurrence-free interval? (2) Does the WHO classification combined with a Ki-67 proliferation index and molecular markers, such as OTP and CD44, offer improved prognostication in low-grade NENs? (3) What is the value of a typical versus atypical carcinoid diagnosis on a biopsy specimen in local and metastatic disease? Diagnosis is difficult in biopsy specimens and recent observations of an increased mitotic rate in metastatic carcinoid from typical to atypical and high-grade NEN can further complicate diagnosis. (4) What is the (ir)relevance of morphologically separating large cell neuroendocrine carcinoma (LCNEC) SCLC and the value of molecular markers (RB1 gene and pRb protein or transcription factors NEUROD1, ASCL1, POU2F3, or YAP1 [NAPY]) to predict systemic treatment outcome? (5) Are additional diagnostic criteria required to accurately separate LCNEC from NSCLC in biopsy specimens? Neuroendocrine morphology can be absent owing to limited sample size leading to missed LCNEC diagnoses. Evaluation of genomic studies on LCNEC and marker studies have identified that a combination of napsin A and neuroendocrine markers could be helpful. Hence, to improve clinical practice, we should consider to adjust our NEN classification incorporating prognostic and predictive markers applicable on biopsy specimens to inform a treatment outcome-driven classification.

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Section: Q3 What Is the Value Of A Typical Or Atypical Carcinoid Diagnosis On A Biopsy Specimen In Local And Metastatic Disease?mentioning

confidence: 99%

Section: Recommendedmentioning

confidence: 99%

Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice

Derks¹,

Rijnsburger²,

Hermans³

et al. 2021

Journal of Thoracic Oncology

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“…Of note, the durvalumab clinical benefit was achieved without impacting patient-reported outcomes [87]. Consequently, durvalumab became the new standard for consolidation therapy for unresectable NSCLC patients whose disease has not progressed following cCRT [88]. Not typical for high-cost drugs such as durvalumab, two independent groups of researchers showed a favorable cost-effectiveness outcome for durvalumab consolidation therapy [89].…”

Section: Immunotherapy-based Consolidationmentioning

confidence: 99%

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer

Oliveira,

Fontes,

Montella

et al. 2023

Current Oncology

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Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

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“… 7 Evaluating the use of durvalumab in routine clinical settings outside of the constraints of clinical trial criteria is important not only for the large subset of patients who are trial ineligible but to also understand the safety and efficacy profile of durvalumab in routine clinical practice. 7 , 8 In particular, patients were recruited to the PACIFIC trial at the conclusion of chemoradiation, therefore their fitness compared with standard clinical cohorts is critical.…”

Section: Introductionmentioning

confidence: 99%

“…Subsets of patients including patients with advanced age, poor performance status, non‐white ethnicity, and certain comorbidities are particularly underrepresented in clinical trials but are commonly encountered in real‐world settings 7 . Evaluating the use of durvalumab in routine clinical settings outside of the constraints of clinical trial criteria is important not only for the large subset of patients who are trial ineligible but to also understand the safety and efficacy profile of durvalumab in routine clinical practice 7,8 . In particular, patients were recruited to the PACIFIC trial at the conclusion of chemoradiation, therefore their fitness compared with standard clinical cohorts is critical.…”

Section: Introductionmentioning

confidence: 99%

Use of durvalumab in stage III non‐small‐cell lung cancer based on eligibility for the PACIFIC study

et al. 2023

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Background Durvalumab following concurrent chemoradiotherapy is standard treatment for unresectable stage III non‐small‐cell lung cancer based on the results of the PACIFIC trial. Based on trial criteria, not all patients are eligible for durvalumab in routine clinical practice. Methods We evaluated eligibility for durvalumab in a real‐world clinical setting and the impact of eligibility on outcomes. Consecutive patients treated with concurrent chemoradiotherapy at two tertiary centers between January 2015 and June 2022 were assessed. Clinical characteristics and outcomes were evaluated based on eligibility criteria for the PACIFIC trial. Results A total of 126 patients were included. Seventy patients (56%) were eligible for durvalumab. Ineligibility was associated with shorter progression‐free survival of 9.7 months versus 18.4 months (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39–0.95, p = 0.029) and overall survival of 26.4 months versus 58.7 months (HR 0.47, 95% CI 0.28–0.80 , p = 0.005). Common reasons for ineligibility were history of previous malignancy (32%) and progressive disease or death during chemoradiotherapy (25%). Ineligible patients who received durvalumab had similar outcomes to eligible patients who received durvalumab. Conclusions In a real‐world cohort, adjuvant durvalumab is safe and beneficial in a substantial proportion of patients who would not have been eligible for the PACIFIC trial.

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Applicability of the PACIFIC trial results in patients not eligible for the PACIFIC trial: Canadian rapid consensus statement and recommendations.

Cited by 3 publications

References 53 publications

Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice

Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer

Use of durvalumab in stage III non‐small‐cell lung cancer based on eligibility for the PACIFIC study

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