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.”
“The use of proton beam radiotherapy and concurrent chemotherapy may improve clinical outcomes for patients with inoperable stage III non-small cell lung cancer (NSCLC), while reducing the toxic effects of treatment, researchers from MD Anderson Cancer Center have found.
“The researchers, led by Joe Y. Chang, MD, PhD, reported that the median overall survival of 26.5 months observed in their study ‘was encouraging, and in accord with our original statistical goal of 24 months.’ ”
The gist: Recent research shows good results for a treatment called stereotactic body radiotherapy (SBRT) for early stage lung cancer patients whose tumors cannot be removed by surgery. The research looked at the 10-year medical records of 300 patients treated with SBRT. 79% of their tumors had “excellent long-term, local control.”
“Analysis of data from an institutional patient registry on stereotactic body radiotherapy (SBRT) indicates excellent long-term, local control, 79 percent of tumors, for medically inoperable, early stage lung cancer patients treated with SBRT from 2003 to 2012, according to research presented today at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. The Symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago Medicine.
“The 300 patients in the study had 340 lesions (tumors) and were treated from October 1, 2003 through December 31, 2012, at the Cleveland Clinic, one of the early adopters of SBRT technology for lung cancer patients in the United States. Patients in the study had a median age of 74 years (range = 37-97 years), a median Karnofsky Performance Status (KPS) of 80 (range = 40-100), and were not candidates for surgery because of associated medical conditions, of which chronic obstructive pulmonary disease (COPD) was the most common (62 percent). Median follow-up was 17.4 months (range = 0.3-112.2 months), with 46.7 percent (140) patients alive at the time of follow-up. Median tumor diameter was 2.4 cm (range 0.1-10 cm), and 36.3 percent of tumors (123) had either no biopsy or a non-diagnostic biopsy. Fifteen percent of patients (45) received two or more SBRT treatments…
” ‘We have been privileged in demonstrating that lung SBRT can now be considered the standard of care for medically inoperable patients with early stage lung cancer,’ said Gregory M.M. Videtic, MD, lead study author, and a radiation oncologist at the Cleveland Clinic Foundation and associate professor of radiation oncology at the Cleveland Clinic Lerner College of Medicine, Case Western Reserve University. ‘Since our results indicate no unusual long term side effects, we are hoping to extend the potential uses of this therapy to more-fit, operable lung cancer patients whose cancer has not spread outside of the lung and to collaborate with other institutions on conducting such a clinical trial. SBRT could provide a more minimally invasive procedure than surgery, with fewer side effects and improved patient outcomes.’ “
The gist: Researchers tested a new melanoma treatment in a clinical trial—a research study with volunteer patients. The treatment combines the targeted drugs dabrafenib and trametinib. All of the patients who participated in the trial had inoperable stage IIIC or stage IV melanoma. Also, each patient’s tumors had one of two particular mutations in the BRAF gene, known as V600E and V600K. In the trial, patients who were treated with the combination therapy had significantly lower chances of their cancer worsening and lower chances of death.
“A world-first study in today’s New England Journal of Medicine heralds the efficacy of a targeted combination drug therapy after reporting major declines in the risk of disease progression and death in people with metastatic melanoma.
“The multi-centre, double-blind, randomised, phase 3 trial compared oral dabrafenib (150 mg twice daily) and oral trametinib (2 mg once daily) combination therapy with oral dabrafenib (150 mg twice daily) and placebo.
“All trial patients had inoperable stage 3C or 4 metastatic melanoma that had a BRAF gene mutation V600E or V600K. Among cancer patients with metastatic melanoma, about 40 per cent have a BRAF gene mutation – an abnormality that assists some melanoma tumours to grow and spread.
“Led by Associate Professor Georgina Long of Melanoma Institute Australia at the University of Sydney, the finding affirms accumulating evidence of the efficacy of targeted combination therapies in extending life and halting disease progression in patients with cancers that carry genetic mutations that resist monotherapies.”
The gist: People with early-stage, non-small cell lung cancer that can’t be removed by surgery may benefit from treatment with stereotactic body radiation therapy (SBRT). That was the conclusion of a recent clinical trial—a research study with volunteer patients. All patients in the trial could not have their tumors surgically removed because of medical conditions like emphysema or heart disease. Five years after SBRT, 40% of the patients were still alive. Cancer returned (recurred) in only 7% of the patients after five years. The researchers say this result is on par with surgery.
“A series of patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) had a 5-year survival of 40% following treatment with stereotactic body radiation therapy (SBRT), results of a cooperative-group trial showed.
“A fourth of the 59 patients remained alive and disease free after a median follow-up of 48 months. The rate of locoregional failure accelerated after 3 years, primarily in untreated areas.
“The frequency of severe toxicity changed little between 3 and 5 years, Robert Timmerman, MD, of the University of Texas Southwestern Medical Center in Dallas, reported here at the American Society for Radiation Oncology meeting.
” ‘The irradiated tumors are very well controlled, with a 5-year primary tumor recurrence rate of only 7%,’ Timmerman said during an ASTRO press briefing. ‘This is on par with surgery. Survival continues to decline as you might expect from a very frail population with competing causes of death, but still very impressive at 5 years at 40%. The median survival is 48 months and 7 years among surviving patients.’ “
The gist: This article discusses a clinical trial—a research study with volunteer patients. The trial tested a radiation treatment for inoperable, early-stage lung cancer. The treatment is called stereotactic body radiation therapy (SBRT). The clinical trial ended in 2008, but researchers have been following the patients who participated. They have now reported that 40% of the patients in the trial were still alive five years after SBRT treatment. These numbers are “encouraging” since conventional radiation therapy has not been very effective for people with inoperable lung cancer.
“Patients with inoperable, early-stage lung cancer who receive stereotactic body radiation therapy (SBRT) have a five-year survival rate of 40 percent, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting. Such a positive survival rate is encouraging considering that historically conventional RT resulted in poor tumor control for patients with inoperable lung cancer. This study is an update of RTOG 02362, originally published in 20101, and also conducted by the original researchers to evaluate tumor control rates and side effects for patients at five years post-treatment.
“RTOG 0236 was a Phase II North American multicenter trial from May 2004 until October 2006 of patients age 18 and older with biopsy-proven peripheral T1-T2 N0M0 non-small cell lung cancer (early stage with no lymph node involvement or metastases). Patients in the study all had medical conditions that precluded them from surgery, so they received SBRT, a specialized type of external beam therapy that uses focused radiation beams at a tumor using detailed imaging. SBRT delivers high doses of radiation to the tumor in a decreased amount of treatment time, compared to standard RT, while minimizing exposure to surrounding healthy organs. SBRT appeared to improve tumor control, as suggested by the initial study results for RTOG 0236.
“A total of 59 patients were accrued for the study, and 55 were evaluable (44 patients with T1 tumors and 11 patients with T2 tumors). Patients each received three fractions of 18 Gy (54 Gy total) of SBRT, and treatment lasted between one-and-a-half to two weeks.”
The gist: This article describes the results of a clinical trial—a research study with volunteer patients. The goal of the trial was to test a new treatment for people with inoperable advanced hepatocellular carcinoma (HCC). The new treatment combines two existing treatments: a chemotherapy drug called sorafenib and Selective Internal Radiation Therapy (SIRT). The results of the trial showed improved survival for the patients who participated. The new treatment will continue to be tested in the hopes that it may prove good enough to be widely used to treat advanced HCC.
“The mature results from a trial conducted by the Asia-Pacific Hepatocellular Carcinoma Trials Group led by the National Cancer Centre Singapore (NCCS) and Singapore General Hospital (SGH) have shown that patients who suffer from inoperable advanced hepatocellular carcinoma (HCC) may have a chance to live significantly longer by using a combined therapy.
“The multi-centre phase II clinical trial was conducted at four Asia Pacific tertiary medical centres to evaluate the efficacy of combining two existing treatment modalities, Sorafenib and Selective Internal Radiation Therapy (SIRT). The combination therapy involves starting patients on SIRT using SIR-Spheres microspheres, a medical device that contains radioactive microspheres labeled with yttrium-90 for short range high energy radiation therapy, followed by systemic therapy with an oral chemotherapy drug, Sorafenib, 14 days later.
“The mature results of the trial published recently in a peer-reviewed journal, PLOS ONE, show that median overall survival was 20.3 months for patients with intermediate stage HCC and 8.6 months for patients with advanced liver cancer. These final results were better than the preliminary data released in 2010.”
“University of Adelaide researchers have discovered that a new trial vaccine offers the most promising treatment to date for melanoma that has spread, with increased patient survival rates and improved ability to stop or reverse the cancer.
“The vaccine, known as vaccinia melanoma cell lysate (VMCL), was given regularly as a treatment to 54 South Australian patients with advanced, inoperable melanoma over a 10-year period.”
Editor’s note: The cancer vaccine VMCL is a type of immunotherapy, which means it boosts a patient’s own immune system to fight cancer.