PACIFIC-R Final Analyses: Data Support ‘Long-Term Benefit’ of Durvalumab After CRT in Unresectable NSCLC

Data from a large cohort in a real-world setting “support the long-term benefit” of consolidation durvalumab after chemoradiotherapy (CRT) in patients with unresectable, stage III non–small cell lung cancer (NSCLC), according to the final analyses of PACIFIC-R.

Andrea Riccardo Filippi, MD, of Università degli Studi di Milano, and colleagues presented the survival outcomes from the final PACIFIC-R data extraction with more than 5 years of follow-up at the European Lung Cancer Congress 2025, in Paris, France.

The PACIFIC trial previously established consolidation durvalumab as the standard of care for patients with unresectable NSCLC and no progression after concurrent CRT, and the PACIFIC-R trial “has since supported the efficacy and tolerability of this regimen in a real-world population,” according to Dr. Filippi and colleagues.

The full analysis set from the international observational study included 1,153 adults with unresectable NSCLC with a median age of 65 years. Nearly all (98.4%) patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. More than half of the patients (53.6%) had a disease stage of IIIB/C, with 46.6% having a disease stage of IIIA.

The patients in PACIFIC-R received IV durvalumab 10 mg/kg once every 2 weeks in an early access program from September 2017 to December 2018. Patients received the treatment after completing concurrent CRT or sequential CRT with no disease progression. Patients received a median of 23 durvalumab infusions (range, 1- 99), with 22.1% receiving durvalumab for more than a year. The primary end points of PACIFIC-R were overall survival (OS) and real-world progression-free survival (PFS).

The median real-world PFS was 24.3 months (95% CI, 20.3-28.4), with a 5-year real-world PFS rate of 35.2% (95% CI, 32.4-38.1). The median OS was 59 months (95% CI, 52.7-64.3), with a 5-year OS rate of 49.2% (95% CI, 46.2-52.2).

The study investigators reported that “encouraging results were observed across subgroups,” including among patients who received durvalumab after either concurrent CRT or sequential CRT and “irrespective of PD-L1 tumor cell expression.”

For patients receiving durvalumab after concurrent CRT, the median real-world PFS was 25.8 months, compared with 23.2 months for those receiving it after sequential CRT. The median OS was 63.1 months in patients receiving durvalumab after concurrent CRT, compared with 47.1 months in those receiving it after sequential CRT.

For patients with PD-L1 expression of at least 1%, the median real-world PFS was 25.5 months, compared with 16.3 months for those with PD-L1 expression of less than 1%. The median OS was 62.4 months in those with PD-L1 expression of at least 1%, compared with 43.3 months in those with PD-L1 expression of less than 1%.

Overall, nearly half (43.7%) of the patients received subsequent therapy, with 16.2% of those patients receiving subsequent immunotherapy.

Based on these mature OS and real-world PFS results, the study investigators concluded that the final analyses from PACIFIC-R “support the long-term benefit of consolidation” durvalumab after CRT. These “encouraging outcomes were observed across subgroups,” and this observation supports the use of the PACIFIC regimen as the “global” standard of care for patients with unresectable NSCLC.

Reference

Filippi AR et al. Real-world 5-year survival outcomes with durvalumab (D) after chemoradiotherapy (CRT) in unresectable, stage III NSCLC (urNSCLC): final data extraction from PACIFIC-R. Abstract #190P presented at: European Lung Cancer Congress 2025, March 26-29; Paris, France.