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World J Clin Oncol. Nov 24, 2020; 11(11): 898-917
Published online Nov 24, 2020. doi: 10.5306/wjco.v11.i11.898
Deep diving in the PACIFIC: Practical issues in stage III non-small cell lung cancer to avoid shipwreck
Xabier Mielgo-Rubio, Federico Rojo, Laura Mezquita-Pérez, Francesc Casas, Amadeo Wals, Manel Juan, Carlos Aguado, Javier Garde-Noguera, David Vicente, Felipe Couñago
Xabier Mielgo-Rubio, Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
Federico Rojo, Department of Pathology, IIS-Jiménez Díaz-CIBERONC Foundation, Madrid 28040, Spain
Laura Mezquita-Pérez, Department of Medical Oncology, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona 08036, Spain
Francesc Casas, Department of Radiation Oncology, Hospital Clinic, Barcelona 08036, Spain
Amadeo Wals, Department of Radiation Oncology, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
Manel Juan, Department of Immunology Service, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
Carlos Aguado, Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid 28040, Spain
Javier Garde-Noguera, Department of Medical Oncology, Hospital Arnau de Vilanova, Valencia 46015, Spain
David Vicente, Department of Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla 49001, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28028, Spain
Author contributions: All authors contributed equally to this work.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xabier Mielgo-Rubio, MD, Staff Physician, Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, Alcorcón, Madrid 28922, Spain. xmielgo@hotmail.com
Received: June 23, 2020
Peer-review started: June 23, 2020
First decision: July 25, 2020
Revised: July 30, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: November 24, 2020
Processing time: 148 Days and 1 Hours
Core Tip

Core Tip: Durvalumab consolidation therapy is the new standard of care in patients with unresectable stage III non-small cell lung cancer treated with concomitant chemoradiotherapy. In the PACIFIC trial, durvalumab significantly improved both progression-free survival and overall survival compared to placebo, with a manageable toxicity profile. However, several questions surrounding the clinical implementation of this therapy remain including optimal patient selection and timing of treatment initiation, programmed cell death ligand 1 determination, and the impact on clinical routines. These questions make interdisciplinary decision-making more necessary than ever. This review assesses these issues and future challenges from a multidisciplinary approach.