Real-life management of stage III non-small cell lung cancer patients in Italy: the BE-PACIFIC observational study

Background: Stage III non-small cell lung cancer (NSCLC) includes a heterogeneous group of patients with diverse disease presentation, biological portrait, and prognosis. Optimal management requires tailored approaches and multimodal strategies through a multidisciplinary team (MDT) decision-making process. The BE-PACIFIC study primarily aimed at describing treatment strategies of stage III NSCLC according to the Italian standard clinical practice, diagnostic work-up and survival outcomes during observation. Patients and methods: The BE-PACIFIC is an observational multicentre retrospective and prospective cohort study, involving both primary data collection and secondary use of data. Adult patients with confirmed diagnosis of stage III NSCLC were included by 40 sites and followed up for 12 months after diagnosis. Results: From 1st August 2019, to 31st July 2020, 311 subjects were enrolled: 296 (95.2%) were evaluable for the analyses. The median (25th-75th percentiles) duration of the diagnostic process was 30.4 (21.0-60.9) days. MDT was involved in treatment plan definition of 88.7% (n/N=260/293) of patients. Sixty (20.3%) patients had tumour resection, mostly associated with neoadjuvant (n=26, 43.3%) or adjuvant (n=22, 36.7%) treatment alone. Chemoradiation was used in 165 of 236 (69.9%) non-resected patients, followed by durvalumab in 80 cases (48.5%). Conclusions: MDT was largely involved in stage III NSCLC management, with at least 75% of patients completing the diagnostic process within 2 months. Consolidation durvalumab was used in half of non-resected patients treated with chemoradiation, with favourable retention rates and response, consistently with the PACIFIC trial findings.