“Before Imfinzi arrived, all physicians could do for a state-3 unresectable non-small cell lung cancer (NSCLC) patient was to shoot CT every two to three months and observe the disease progress. But now, few doctors do not use Imfinzi as remission consolidation treatment after chemotherapy. Imfinzi showed clinically meaningful results in the PACIFIC study and is now reimbursable. So, there is no reason for this patient group not to use Imfinzi.”

So said Professor Lim Sun-min of Yonsei Cancer Center’s Lung Cancer Center in a recent interview with Korea Biomedical Review.

Professor Lim Sun-min of Yonsei Cancer Center’s Lung Cancer Center said patients with stage-3 unresectable non-small cell lung cancer should get Imfinzi treatment.

Imfinzi (ingredient: durvalumab) won the national health insurance benefit in April and has become one of the standard therapy options for stage-3 unresectable NSCLC patients.

Unresectable stage-3 NSCLC patients include those of Tumor 4 (T4) and Node 2-3 (N2-N3) stages and they account for about 20 percent of all lung cancer patients, according to Lim.

In this patient group, chemotherapy has been the standard of care for the past 30 years.

Many researchers studied cytotoxic and targeted therapies in several trials but all have failed, she said.

“Chemotherapy surely reduces cancer cells in these patients but CT scanning in some cases showed remaining lesions,” Lim said.

In the past, physicians had no other choice but to wait and watch the disease progress, while shooting CT scans every two or three months, she added.

However, the PACIFIC trial on Imfinzi yielded encouraging outcomes, extending the overall survival of patients, Lim noted.

Before the arrival of Imfinzi, only 15 to 30 percent of patients treated with chemotherapy survived for at least five years.

In contrast, the PACIFIC data showed that 57 percent of the Imfinzi-treated group survived for three years, versus 44 percent of the control arm. The results showed that additional Imfinzi treatment lowered the risk of death by 31 percent, compared to chemotherapy, Lim explained.

Almost all medical staff at local hospitals that provide multidisciplinary patient care are using Imfinzi as remission consolidation therapy after chemotherapy, Lim went on to say.

“To increase the overall survival, we need Imfinzi treatment. It prolonged progression-free survival almost three times as compared to that of the control group, and it also improved the response rate,” she said.

With the insurance benefits available now, there is no reason not to use Imfinzi for patients with unresectable stage-3 NSCLC, she added.

After Imfinzi won reimbursement, the drug regulator set new criteria, called “temporary therapy” for giving reimbursement to other immunotherapies. As the government allowed insurance benefits to Imfinzi as “therapy for complete cure,” patients who responded to Imfinzi can use other immune checkpoint inhibitors even if their disease relapses or progresses.

Under the current criteria for reimbursement, as long as patients with unresectable stage-3 NSCLC meet the condition of PD-L1 positive expression, they can get Imfinzi treatment after concurrent chemoradiotherapy, Lim said.

If the disease recurs six months after Imfizi treatment, patients can use other immunotherapies that are reimbursable.

The six months is set because recurrence within six months shows that the patient did not respond to anti-PD-L1 drugs, she added.

kym@docdocdoc.co.kr

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