SBRT/Erlotinib Yield Big Improvements in Stage IV NSCLC

The gist: Stage IV non-small cell lung cancer (NSCLC) patients who receive stereotactic body radiation therapy (SBRT) along with the drug erlotinib may experience a longer amount of time before their cancer worsens. That was the conclusion of a recent clinical trial with 24 volunteer patients. In the trial, patients went for 14.7 months without their cancer worsening, compared to the historical rate of 2 to 4 months.

“A small trial yielded ‘dramatic’ results with high progression-free and overall survival using stereotactic body radiation therapy (SBRT) along with erlotinib for patients with stage IV non–small-cell lung cancer (NSCLC).

“ ‘Historically, drug therapy has failed to durably control gross visible tumors in most patients,’ said Robert Timmerman, MD, of the UT Southwestern Medical Center in Dallas, in an email. ‘In our new treatment paradigm, the SBRT, not the drugs, controls gross disease. Instead the drug is used to avoid the appearance of new tumors that would have otherwise progressed from microscopically hidden tumor.’

“The new trial was a single-arm, phase II study including 24 patients with a median age of 67 years. All patients had progressed through platinum-based chemotherapy, and the median follow-up was 11.6 months. Results were published online ahead of print on October 27 in the Journal of Clinical Oncology. After erlotinib treatment began for each patient, SBRT was delivered to all disease sites.

“The median progression-free survival was 14.7 months, and the median overall survival was 20.4 months. Though this trial had no comparator arm, these are substantially longer than historical studies of NSCLC patients who receive systemic therapy; typically progression-free survival and overall survival are 2 to 4 months and 6 to 9 months, respectively…

“ ‘The experience is exciting because the intervention seems to have dramatically changed the onset and pattern of failure,’ Timmerman said. ‘Our 14.7 month progression-free survival means that patients had an extended ‘holiday’ from progression during which they could get on with their lives and stop having to focus on finding yet another treatment.’ “