S752
Clinical - Lung
ESTRO 2026
Purpose/Objective: The PACIFIC regimen represents standard of care treatment for patients with unresectable locally advanced non-small cell lung cancer (NSCLC)1. This treatment involves concurrent chemoradiation (cCRT) followed by consolidation immunotherapy (IO) and confers improved outcomes. Nevertheless, eligible patients may face barriers to accessing this therapy2. We hypothesize that characterizing patient pathways to receiving cCRT and IO at a single institution will demonstrate patient outcomes in real world practice and reveal factors impeding timely access to standard of care therapy. Material/Methods: Patients with non-operable stage III NSCLC that were diagnosed and initiated on cCRT were identified at one institution between January 1, 2020 and December 31, 2022. Numerous timeframes were delineated, such as duration between various diagnostic tests, referrals, multidisciplinary rounds discussion, consultations, and initiation and cessation of cCRT and IO. The diagnostic interval was defined as days from first abnormal CT scan to initial oncologist consultation. The treatment initiation interval was defined as days from abnormal CT scan to cCRT start. Progression-free survival was defined as the duration from first day of cCRT to date of radiologic progression, or death. Overall survival was defined as the duration from first day of cCRT to date of death. Results: Sixty patient pathways were evaluated. The median diagnostic interval was 71 days and the median treatment initiation interval was 90.5 days. Median time from oncology referral to oncology consult was 19 days and from oncology referral to initiation of cCRT was 29.5 days. Among the 60 patients, 16 (26.7%) did not receive IO due to progression during cCRT or poor performance status. All 44 patients eligible for IO were initiated on consolidation treatment. Of these 44 patients, 33 (75%) started IO within 42 days of completing cCRT and 23 (52%) completed 12 months of IO, as detailed in the PACIFIC protocol. Among all 60 patients, the median progression free survival (mPFS) and median overall survival (mOS) were 19 months and 38 months, respectively. In the 44 patients that completed cCRT and were started on IO, the mPFS and mOS were 30 months and 49 months, respectively. Conclusion: Patient accessibility to the PACIFIC regimen at a single institution was elucidated. We determined areas to continue, including initiating 100% of eligible patients on IO. These findings also indicate areas for improvement and will inform development of quality improvement initiatives. Multidisciplinary collaboration will be necessary to identify and implement strategies to improve treatment accessibility and patient outcomes.
fractions) or active surveillance (n=39) groups. Data on demographics, treatment, outcomes, and toxicities were extracted from electronic records and radiotherapy planning systems. Survival analyses used Kaplan-Meier estimates. Results: The cohort had a median age of 68 years (IQR: 60.5– 75.5), 63.6% female, and 36.4% received sequential chemoradiotherapy. Patients in the PCI group were younger (mean 62.3 vs. 72.9 years, p<0.01) and more likely to receive concurrent chemoradiotherapy (76% vs. 50%). BM occurred in 20% (n=15), with a higher incidence in the surveillance group (26.3% vs. 13.5%). Median follow-up was 47 months (IQR: 27–73); 38 deaths occurred (27 lung cancer-related). Median OS was 45.0 months (95% CI: 21.0–79.0), with 6, 12, 24- , 36-, 48- and 60-month OS probability being 98.7%, 84.8%, 60.9%, 53.3%, 42.9% and 39.8% respectively. Intracranial relapse correlated with worse OS (21 vs. 63 months, p<0.001). PCI showed a non-significant OS benefit (49 vs. 21 months, p=0.074)The median time to CNS relapse was shorter in the surveillance cohort compared with the PCI cohort; however, this was not statistically significant (10 vs 22 months, p = 0.09). Extracranial disease (ECD) progression occurred in 28 patients (37.3% event rate), ECD-free survival rates were 97.3%, 80.4%, 65.5%, and 56.2% at 6, 12, 24, and 60 months, respectively. Patients who developed CNS relapse had significantly worse ECD-free survival (p = 0.0037). PCI-related toxicity occurred in 43.2% (fatigue: 33.3%; cognitive impairment: 5.6%; stroke: 2.8%). Conclusion: Intracranial relapse rates were low, in general (20%), but higher with surveillance alone. PCI was associated with delayed intracranial relapse and a trend toward improved OS, though not statistically significant. CNS relapse strongly predicted poorer OS and ECD control, underscoring the interplay between intracranial and systemic disease. PCI was generally well-tolerated,
with fatigue as the most common toxicity. Keywords: Small-cell lung cancer, PCI, Active surveillance
Digital Poster 105 Improving patient pathways to accessing the PACIFIC regimen Connie Le 1 , Kelvin Young 2 , Randeep Sangha 2 , Brock J Debenham 3 1 Oncology, University of Alberta, Edmonton, Canada. 2 Medical Oncology, Cross Cancer Institute, Edmonton, Canada. 3 Radiation Oncology, Cross Cancer Institute, Edmonton, Canada
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