High-Dose Radiotherapy Fails to Improve Prostate Cancer Survival

“A high-dose radiotherapy schedule did not improve overall survival (OS) compared with the standard dose in men with stage II localized prostate cancer. But, local disease control and rates of distant metastasis were improved.

“After a median follow-up of 7 years, the 5-year OS rates were 88% and 89% in the high-dose and standard radiotherapy arms, and the 10-year OS rates were 67% and 66% in the high-dose and standard arms, respectively (P = .87).

“The results (Abstract 4) of the Radiation Therapy Oncology Group (RTOG) 0126 phase III trial were presented by Jeff M. Michalski, MD, of Washington University School of Medicine in St. Louis, at the 2015 Genitourinary Cancers Symposium.

“ ‘Disappointingly, we did not see an improvement in OS as we had hoped,’ Michalski told Cancer Network. ‘Dose escalation did not significantly decrease the rate of death from prostate cancer.’ ”

Adding Higher Dose Radiation or Cetuximab Doesn't Benefit Stage III NSCLC Patients Receiving Chemoradiation

The gist: An attempt to improve treatment for stage III non-small cell lung cancer (NSCLC) patients failed when it was tested in a clinical trial. People with stage III NSCLC are normally treated with radiation and chemotherapy. Researchers wondered if giving higher-dose radiation or adding the drug cetuximab (Erbitux) would improve the standard treatment. However, when tested in patients, neither approach worked better than the standard approach.

“As reported in The Lancet Oncology by Bradley and colleagues, the phase III Radiation Therapy Oncology Group 0617 trial showed no survival benefit of high- vs standard-dose radiotherapy or for addition of cetuximab (Erbitux) to concurrent paclitaxel-carboplatin chemoradiation in patients with inoperable stage IIIA or IIIB non–small cell lung cancer (NSCLC).

“In the open-label 2×2 factorial trial, patients from the United States and Canada were randomly assigned 1:1:1:1 between November 2007 and November 2011 to receive 60 Gy radiotherapy (n = 166), 74 Gy radiotherapy (n = 121), 60 Gy radiotherapy and cetuximab (n = 147), or 74 Gy radiotherapy and cetuximab (n = 110) with all patients receiving concurrent once-weekly chemotherapy with paclitaxel at 45 mg/m2 and carboplatin at area under the curve (AUC) 2. Two weeks after chemoradiation, patients received two cycles of consolidation paclitaxel at 200 mg/m2 and carboplatin at AUC 6 separated by 3 weeks. Radiation was given in 2-Gy daily fractions with either intensity-modulated or three-dimensional conformal radiation therapy. Cetuximab was given at 400 mg/m2 on day 1 followed by 250 mg/m2 weekly continued through consolidation therapy. The primary endpoint was overall survival.

“Patients had a median age of 64 years, and most were male (55%–64%), white (82%–89%), had Zubrod performance status of 0 (55%–59%), were current smokers (43%–51%), received three-dimensional conformal radiotherapy (47%–54%), underwent positron-emission tomography (PET) staging (89%–91%), had squamous histology (42%–47%), and had stage IIIA disease (63%–66%).”

Studies Report New Findings on Treatment Options for Mesothelioma

The gist: This article discusses new findings for mesothelioma treatment from two research studies. The first study was a clinical trial—a research study with volunteer patients. The researchers found that people with malignant pleural mesothelioma who have been treated with chemotherapy and surgery unfortunately do NOT benefit from further treatment with high-dose radiation therapy. The second study was more promising. It found that 20% of people with malignant pleural mesothelioma have cancer cells that express the immune system protein PD-L1. This is important because immunotherapy drugs have already been developed to fight cancers that express PD-L1, such as other forms of lung cancer and melanoma. Clinical trials may soon test whether mesothelioma patients could benefit from anti-PD-L1 drugs.

“Treating patients with high-dose radiotherapy after chemotherapy and surgery for malignant pleural mesothelioma does not achieve improvements in local relapse and overall survival, according to data from a prospective randomized phase II trial presented at ESMO 2014 Congress in Madrid.

” ‘Mesothelioma remains a difficult disease to find better treatment options for, so we asked whether high-dose hemithoracic radiotherapy would decrease the rate or delay the time of local recurrence after chemotherapy and radical surgery,’ says lead author Prof Rolf A. Stahel, from the Clinic and Policlinic for Oncology, at the University Hospital Zurich, Switzerland, and current President of the European Society for Medical Oncology.

“The multicentre trial included 153 patients with surgically-treatable malignant pleural mesothelioma, who were first treated with three chemotherapy cycles of cisplatin and pemetrexed, followed by surgical removal of affected lung tissue, with the goal of complete removal of the cancerous areas of lung.”

Long-Term Androgen Deprivation (LTAD) Therapy Combined with High-Dose Radiation Therapy (HDRT) for Prostate Cancer Improves Biochemical Control and Survival Rates

The gist: This article discusses the results of a clinical trial—a research study with volunteer patients. The goal of the trial was to compare two slightly different prostate cancer treatments. The patients in the trial were divided into two groups. All patients were treated with high-dose radiation therapy (HDRT) followed by androgen deprivation therapy (ADT). One group received ADT for 28 months, while the other group received 4 months of ADT. The researchers found that people with the longer ADT schedule had better survival rates.

“Prostate cancer patients who receive high-dose radiation therapy (HDRT) followed by a longer period of hormone suppression therapy, or androgen deprivation therapy (ADT), have higher five-year biochemical, disease-free survival (bDFS) and overall survival rates compared to patients who receive HDRT and a shorter duration of ADT, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.

“Because prostate cancer cells typically require androgen hormones such as testosterone to grow, ADT is often recommended for patients with prostate cancer. Radiation therapy (RT) combined with ADT is an established, standard of care for patients with locally advanced prostate cancer.

“This multi-center study evaluated whether HDRT combined with long-term androgen deprivation (LTAD) therapy for 28 months was associated with better patient outcomes compared to HDRT combined with short-term ADT (STAD) for four months. ”