Implications for UK practice of the use of durvalumab in stage III NSCLC

Background: The PACIFIC trial showed a survival benefit in patients receiving Durvalumab after concurrent chemoradiotherapy (CRT) in stage III Non-Small Cell Lung Cancer (NSCLC). Key inclusion criteria were platinum doublet chemotherapy with no chemotherapy delivered after concurrent phase. Dose delivered was 54 - 66Gy and treatment started within 42 days of completing radiotherapy. European licence is restricted to patients with PDL1 positive tumours. Previous UK audits have shown a number of CRT regimens in routine use. We assessed the implications to UK practice of adding durvalumab after CRT. Methods: A 9 point questionnaire was sent by email to all 50 radiotherapy centres delivering chemoradiotherapy for NSCLC in the UK. Results: 21 responses were received (42%) at the time of submission. Rates of concurrent treatment ranged from 10 - 90% (median 40%, IQR 25-60%) with median surgery rates for N2 disease of 10%. Doses delivered ranged from 55 to 66 Gy (median 60, IQR 55 – 64 Gy) in a median of 30 fractions (IQR 20 to 32). 10 centres used hypofractionated regimens. The most common chemotherapy back-bone was cisplatin and vinorelbine (1 centre used carboplatin and 1 etoposide routinely). 11 centres prescribe chemotherapy post concurrent treatment. Currently only 3 centres scan within the 6 week window after completion of treatment. The majority of centres are now planning to avoid giving consolidative chemo after concurrent CRT and will scan early after CRT. 13 centres are already testing PDL1 in this context. Durvalumb will be supervised in 16 centres by a clinical oncologist, in 2 by medical oncologist with the remaining 3 undecided. Conclusions: The implementation of consolidative Durvalumab in stage III NSCLC post concurrent CRT will require changes in practice in the majority of UK centres. Most centres have already implemented some changes but more work needs to be done to standardise practice and ensure equality of access for patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.