Lung Cancer Patients Whose Tumour Has Spread to the Brain Could Be Spared Radiotherapy

Excerpt:

“Patients with non-small cell lung cancer which has spread to the brain could be spared whole brain radiotherapy as it makes little or no difference to how long they survive and their quality of life according to a Cancer Research UK-funded clinical trial published today in The Lancet(link is external).

“Around 45,500 people are diagnosed with lung cancer in the UK every year and an estimated 85 per cent of cases are non-small cell lung cancer. Up to 30 per cent of patients with non-small cell lung cancer have the disease spread to the brain.”

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Concurrent SRS, Immunotherapy Improved Response in Melanoma Brain Mets

Excerpt:

“Undergoing immunotherapy within a month of stereotactic radiosurgery (SRS) for the treatment of melanoma brain metastases resulted in an improved response to treatment compared with undergoing the two treatments with a longer amount of time between them, according to the results of a study published in Cancer.

“Patients in the study who underwent the two therapies within 4 weeks of each other had a significantly greater median percent reduction in lesion volume regardless of whether SRS occurred before or after immunotherapy.”

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Pembrolizumab Shows Activity in Brain Metastases from NSCLC, Melanoma

Excerpt:

“Pembrolizumab demonstrated therapeutic activity in brain metastases of patients with non–small cell lung cancer or melanoma, according to early results of an ongoing randomized phase 2 trial.

“ ‘In the United States, about 50,000 patients with metastatic melanoma or non–small cell lung cancer develop brain metastases every year. … At diagnosis, 10% of patients with metastatic NSCLC have brain metastases and another 30% develop brain involvement,’ Sarah B. Goldberg, MD, MPH, assistant professor in the department of medical oncology in the Smilow Cancer Hospital at Yale School of Medicine, and colleagues wrote. ‘Many effective drugs in development have not been well studied for central nervous system penetrations, and patients with untreated brain metastases are excluded from most clinical trials.’ ”

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Pfizer Presents Promising Data from Next Generation ALK/ROS1 Inhibitor in Advanced Non-Small Cell Lung Cancer

Excerpt:

“Pfizer Inc. (NYSE:PFE) today announced encouraging new data from a Phase 1/2 study of lorlatinib, the proposed generic name for PF-06463922, Pfizer’s investigational, next-generation ALK/ROS1 tyrosine kinase inhibitor. The study showed clinical response in patients with ALK-positive or ROS1-positive advanced non-small cell lung cancer (NSCLC), including patients with brain metastases. These data were presented today in an oral presentation at the 52nd Annual Meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

“The results presented are from the dose escalation component of an ongoing Phase 1 study of patients with ALK-positive or ROS1-positive NSCLC, with or without brain metastases, who were treatment-naïve or had disease progression after at least one prior tyrosine kinase inhibitor (TKI). Among patients with ALK-positive metastatic NSCLC, the overall response rate (ORR) with lorlatinib was 46 percent, with three patients achieving complete responses and 16 patients achieving a partial response (95% CI: 31-63). The median progression free survival (PFS) was 11.4 months (95% CI: 3.4 – 16.6). The majority of patients had received two or more prior ALK TKIs. Additionally, lorlatinib showed the ability to decrease the size of brain metastases in patients with ALK-positive or ROS1-positive metastatic NSCLC.”

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Nivolumab Combined with Radiation Therapy May Be New Treatment Option for Patients with Melanoma Brain Metastases, Say Moffitt Cancer Center Researchers

“President Jimmy Carter’s battle with metastatic melanoma to the brain has placed increased attention on management of this disease. President Carter was treated with focused stereotactic radiation to the brain and anti-PD-1 therapy. Researchers at Moffitt Cancer Center recently reported the first series of patients treated with this combined modality approach. They found that radiation therapy combined with the immune-targeting drug nivolumab in melanoma patients with brain metastases is safe and improves their survival compared to historical data.

“Nivolumab is a therapeutic agent that targets a protein on immune cells called PD-1. Binding of PD-1 to its ligand PD-L1, which is found on tumor cells, causes immune cells to decrease their activity and allows cancer cells to escape immune detection and cell death.  Nivolumab blocks the PD-1/PD-L1 interaction and restimulates the body’s own immune system to target tumor cells. Nivolumab has been approved by the Food and Drug Administration to treat advanced non-small cell lung cancer, renal cell carcinoma, and melanoma; however, the impact of nivolumab on brain metastases is unclear.”


Afatinib Shows Clinical Benefit for Lung Cancer Patients with Brain Metastases

“Non-small cell lung cancer (NSCLC) patients with common epidermal growth factor (EGFR) mutations and brain metastases showed improved progression-free survival (PFS) and response from the EGFR tyrosine kinase inhibitor (TKI) afatinib compared to standard platinum doublet chemotherapy.

“More than 25% of with advanced NSCLC experience progression to the brain from their primary lung and this number increases to 44-63% for those NSCLC tumors driven by EGFR mutations. Prognosis is poor and typically ranges for 1-5 months for those with . EGFR TKIs are highly effective therapies for advanced NSCLC driven by EGFR mutations, especially the common mutations, exon 19 deletions and L858R point mutations. Even though there are a number of EGFR TKIs approved for first-line therapy of EGFR mutation positive NSCLC, there is a scarcity of prospective data for EGFR TKIs in patients with brain metastases.”


Preliminary Phase 2 Data Demonstrate Tumor Treating Fields Is Safe In Patients With Brain Metastases Originating From Non-Small Cell Lung Cancer

“Preliminary data from COMET, a phase 2 randomized trial sponsored by Novocure (NASDAQ: NVCR), show that the use of Tumor Treating Fields (TTFields) therapy is safe in the treatment of brain metastases originating from non-small cell lung cancer (NSCLC). The results of a preliminary analysis of the ongoing European study were presented Nov. 20 at the 20 th Annual Society for Neuro-Oncology Meeting in San Antonio.

“The preliminary analysis of the randomized COMET trial included 17 patients, six of whom were treated with TTFields plus supportive care and 11 of whom received supportive care alone, following stereotactic radiosurgery with or without surgical resection of the brain metastases. Patients treated with TTFields plus supportive care received TTFields applied to the brain at the specific frequency of 150 kHz, which has been shown in preclinical studies to be the optimal frequency for inhibiting mitosis of NSCLC cells. In both arms of the study, a total of 26 adverse events were reported, most of which stemmed from the underlying NSCLC. A single event, mild dermatitis, was the only complication linked to TTFields therapy. No serious adverse events related to TTFields therapy were reported.”


No Benefit to Afatinib in HER2-Positive Breast Cancer With Brain Metastases

“The use of afatinib or afatinib plus vinorelbine during or after treatment with trastuzumab, lapatinib, or both failed to show a patient benefit in women with HER2-positive breast cancer with progressive brain metastases compared with investigator’s choice of treatment, according to the results of a phase II study published in Lancet Oncology.

“Afatinib, an oral inhibitor of the ErbB family of proteins, did benefit about one-third of patients assigned to the treatment, but had no better activity than investigator’s choice of therapy, which consisted mostly of trastuzumab or lapatinib plus chemotherapy.

“ ‘No objective responses were achieved in patients treated with afatinib alone, but around one-third of patients, including those treated with afatinib alone, did not have disease progression during the first 12 weeks,’ wrote researcher Javier Cortés, MD, of Vall d’Hebron Institute of Oncology in Barcelona, and colleagues. ‘No further development of afatinib for HER2-positive breast cancer is currently planned.’ “


Prognostic Factors Identified in Patients With ALK‑Rearranged NSCLC and Brain Metastasis

“In a study reported in the Journal of Clinical Oncology, Johung and colleagues identified factors that distinguished survival rates among patients with ALK-rearranged non–small cell lung cancer (NSCLC) and brain metastasis.

“The study included 90 patients from six institutions. Of them, 84 patients had received radiotherapy to the brain, consisting of stereotactic radiosurgery or whole-brain radiotherapy, and 86 patients had received tyrosine kinase inhibitor therapy (crizotinib [Xalkori] in 84 and a second-generation tyrosine kinase inhibitor in 41).”