The Sequencing Paradox of Immunotherapy and Thoracic Radiotherapy
Mené sur 68 patients atteints d'un cancer du poumon à petites cellules de stade étendu, cet essai randomisé multicentrique de phase II évalue l'intérêt, du point de vue de la survie globale, d'ajouter une radiothérapie thoracique de consolidation à un traitement d'entretien standard par atézolizumab
Following the paradigm-changing results of the PACIFIC trial, it was logical to test whether concurrent immune checkpoint inhibitors (ICIs) and thoracic radiotherapy (TRT) would result in superior patient outcomes for patients with locally advanced lung cancer. It is clear that such approaches should be reconsidered.In the decade since PACIFIC, we now know that including draining thoracic lymph nodes in the TRT ports. as well as regular daily fractionation, may compromise that intended effect of combined ICI plus TRT. The PACIFIC-2 investigators hypothesized, in part from promising preclinical studies, that adjusting the sequencing of modalities by moving ICI therapy up front to start with chemoradiotherapy, more patients would actually receive consolidation immunotherapy and the therapeutic ratio would be improved. The results failed to demonstrate any improvement in progression-free survival with durvalumab vs placebo (hazard ratio, 0.85; 95% CI, 0.65- 1.12; P = .25).
JAMA Oncology , éditorial, 2026