American Society for Radiation Oncology | Sep 24, 2017
“Long-term results of a phase III clinical trial indicate that survival rates for patients receiving chemoradiation for unresectable, locally advanced non-small cell lung cancer (NSCLC) may be more than twice as high as previous estimates. At five years following treatment with a standard dose of 60 Gray (Gy) radiation delivered in 30 fractions, the overall survival rate was 32 percent, setting a new benchmark of survival for patients with inoperable stage III NSCLC. The trial, RTOG 0617, also confirms that a standard dose of radiation therapy is preferable to a higher dose and that cetuximab offers no additional survival benefit for these patients. Findings will be presented today at the 59th Annual Meeting of the American Society for Radiation Oncology (ASTRO) in San Diego.”
“Chemoradiotherapy (CRT) is associated with survival benefit over chemotherapy (CT) alone for elderly patients with limited-stage small-cell lung cancer, according to a study published online Oct. 19 in the Journal of Clinical Oncology.
“Christopher D. Corso, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined outcomes for elderly patients (≥70 years) treated with CT versus CRT. Data were included for 8,637 patients with limited-stage small-cell lung cancer in the National Cancer Data Base between 2003 and 2011.
“The researchers found that 43.7 and 56.3 percent of the patients received CT and CRT, respectively. CRT receipt was less likely with increasing age, clinical stage III disease, female sex, and the presence of medical comorbidities (all P < 0.01). Compared with CT, CRT use correlated with increased overall survival on univariate and multivariate analysis (median overall survival, 15.6 versus 9.3 months). Survival benefit associated with CRT was confirmed in a propensity score-matched cohort of 6,856 patients (hazard ratio, 0.52; P < 0.001). In subset analysis, patients who were alive at four months after diagnosis had a survival benefit with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”
Results from a phase II clinical trial suggest that combining the cancer drug S-1 (Teysuno) with the chemotherapy agent cisplatin (Platinol) and radiation therapy may be effective in non-small cell lung cancer (NSCLC). Patients with inoperable, locally advanced NSCLC were treated with S-1, Platinol, and radiation to the chest region. Tumors shrank at least 30% in 36 out of 41 patients. Although some patients experienced low levels of white blood cells, overall the treatment was well tolerated. S-1 is itself a combination of tegafur (a chemotherapy agent), gimeracil (which boosts tegafur levels in the body), and oteracil (which protects the stomach and gut from tegafur toxicity.
Past studies have suggested that the diabetes drug metformin (Glucophage) may make lung cancer tumors more susceptible to radiation and therefore, make radiation therapy more effective. Researchers therefore analyzed the medical records of patients with locally advanced non-small cell lung cancer (NSCLC) who had been treated with radiation and chemotherapy. Sixteen of these patients had been taking Glucophage at the time. All of the Glucophage-treated patients are still alive and the cancer has returned in only two so far (an average of 10.4 months after the treatment)–better outcomes than what was seen in the patients who were not on Glucophage. Glucophage also made tumors more sensitive to radiation treatment in a mouse model of lung cancer.
A new clinical trial will reexamine the lung cancer vaccine tecemotide, formerly known as Stimuvax. Tecemotide stimulates the patient’s immune system to attack tumor cells. Although the drug previously failed in the START clinical trial, drugmakers reported that later analyses showed that tecemotide increased survival in the subset of patients who had been treated with chemoradiotherapy (simultaneous chemotherapy and radiation therapy, or CRT) before tecemotide. Like START, the new trial, START2, will enroll patients with locally advanced, stage III non-small cell lung cancer (NSCLC) that cannot be removed with surgery. However, START2 will exclusively focus on patients who have previously received CRT.
People with advanced non-small cell lung cancer (NSCLC) are usually treated with chemotherapy and radiotherapy. However, radiation interferes with the standard method of scanning for lung abnormalities, computed tomography (CT), making its measurements difficult to interpret. This creates the risk that leftover tumor fragments or new cancer spread may be overlooked. A different imaging methodology, fluorodeoxyglucose-positron emission tomography (FDG-PET), may be more accurate in such patients. FDG-PET measures sucrose uptake into cells. High uptake values indicate highly active cells, suggesting the presence of cancerous tissue. In a recent clinical trial, higher standardized uptake values (SUVs) in FDG-PET scans predicted lower survival in people with stage III NSCLC who had received chemotherapy and radiotherapy, suggesting that the method accurately detected cancerous tissue.
Disagreement persists about the best treatment for non-small cell lung cancer (NSCLC) patients with stage IIIA(N2) disease, that is, cancer that has spread to lymph nodes just outside the lung. A recent study compared the outcomes of different treatments. Patients who had received neoadjuvant chemoradiotherapy (chemotherapy and radiation administered before surgery) followed by lobectomy (removal of the lung subsection containing the cancer) had higher 5-year survival rates than patients treated with:
-neoadjuvant chemoradiotherapy and pneumonectomy (removal of the whole lung containing the cancer);
-either lobectomy or pneumonectomy plus adjuvant therapy (chemotherapy and/or radiation administered after surgery);
-concurrent chemoradiotherapy (chemotherapy and radiation delivered at the same time, without surgery).
These findings suggest that neoadjuvant chemoradiotherapy followed by lobectomy is the preferable treatment for stage IIIA(N2) NSCLC.
Standard-dose radiation therapy gives better results compared to high-dose radiation in patients with locally advanced stage III non-small cell lung cancer (NSCLC), a recent clinical trial showed. Patients treated with 60 Gy of radiation had longer median survival (28.7 vs 19.5 months) and higher 18-month survival rates (66.9% vs 53.9%) compared to those receiving 74 Gy of radiation. Standard-dose therapy resulted in less cancer spread, lower rates of recurrence, and fewer severe side effects and treatment-related deaths than high-dose radiation. All patients also received chemotherapy with or without cetuximab (Erbitux) in addition to radiation; a future analysis will look at whether Erbitux helped survival.
The drug amifostine (Ethyol) reduces toxic side effects of chemotherapy and radiation. However, scientists are concerned that Ethyol may also protect tumors and undermine cancer treatment. To test this, a clinical trial examined the effects of Ethyol in patients with stage II and IIIA/B non-small cell lung cancer (NSCLC) who were treated with radiation and chemotherapy simultaneously. Patients who took Ethyol experienced no differences in survival or cancer progression compared to those who did not take Ethyol, suggesting that the drug did not undermine treatment. However, Ethyol did not improve quality of life or reduce throat inflammation during treatment. It did appear to lessen swallowing difficulties. Not enough patients participated in the study to completely rule out a potential effect of Ethyol on survival, so further studies are needed.