‘Eye-Popping’ pCR Rate With SABR Alone in Early Lung Cancer


“Stereotactic ablative radiotherapy (SABR) yielded a surprisingly low pathologic complete response (pCR) rate in a phase II trial of operable, early-stage lung cancer patients, raising questions about SABR alone in this setting.

“In the first study to examine neoadjuvant SABR prior to surgery in non-small cell lung cancer (NSCLC), SABR yielded a 60% pCR rate at 10 weeks post-radiation (95% CI 44%-76%), a rate far lower than hypothesized when the trial was designed, reported David Palma, MD, PhD, of the London Health Sciences Centre in London, Ontario, Canada, and colleagues, in JAMA Oncology.”

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Zapping Tumor Effective for Stage I Non-Small Cell Lung Cancer (CME/CE)

“Overall survival rates for resectable stage I non-small cell lung cancer (NSCLC) might improve if treated with stereotactic ablative radiotherapy (SABR) rather than lobectomy, the current standard of care, reports a phase III randomized U.S.-Dutch study led by researchers from the University of Texas MD Anderson Cancer Center in Houston.

“Furthermore, SABR is better tolerated.

“The findings, published in The Lancet Oncology, on May 14, 2015, are the first available data from randomized trials comparing SABR and invasive surgery with mediastinal lymph node dissection or sampling. Nonrandomized studies have previously suggested that SABR might be as effective as surgery, but these results are the first randomized data.

” ‘For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,’ said principal investigator Joe Y. Chang, MD, PhD, a professor of radiation oncology, in an MD Anderson media release. ‘This study can give physicians confidence to consider a noninvasive option.’ “

Stereotactic Ablative Radiotherapy Achieves Better Overall Survival than Surgery for Early Lung Cancer

“Patients with operable stage I non-small cell lung cancer (NSCLC) could achieve better overall survival rates if treated with Stereotactic Ablative Radiotherapy (SABR) rather than the current standard of care — invasive surgery — according to research from a phase III randomized international study from The University of Texas MD Anderson Cancer Center.

“The findings, published today in The Lancet Oncology, are from the first randomized clinical trials comparing SABR and surgery.

” ‘For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,’ said the first author and principal investigator Joe Y. Chang, M.D., Ph.D., professor, Radiation Oncology. ‘Stereotactic radiation treatment is a relatively new approach for operable early stage lung cancer, while surgery has been the standard for a century. This study can give physicians confidence to consider a non-invasive option.’ “

Researchers Find Removal of Entire Lobe of Lung Offers Increased Survival Benefit Compared to Partial Resection

“Removal of the entire lobe of lung may offer patients with early-stage lung cancer better overall survival when compared with a partial resection, and stereotactic ablative radiotherapy (SABR) may offer the same survival benefit as a lobectomy for some patients, according to a study from The University of Texas MD Anderson Cancer Center.

“The research is the largest population-based study to review modern treatment modalities for early-stage lung cancer and is published in JAMA Surgery.

“According to the American Cancer Society, in 2014, 224,210 people in the U.S. are expected to be diagnosed with lung cancer, and more than 159,260 will die from the disease. Yet with the aging baby-boomer population colliding with spiral CT-screening’s acceptance as a screening tool for lung cancer, the number of cases diagnosed is expected to rise dramatically, says Shervin M. Shirvani, M.D., attending radiation oncologist at Banner MD Anderson Cancer Center in Arizona and an adjunct professor at MD Anderson.”

Select Group of Stage IV Lung Cancer Patients Achieve Long-Term Survival After Aggressive Treatments

The gist: A recent research study examined the effects of particularly aggressive treatment for stage IV non-small cell lung cancer (NSCLC). Aggressive treatment can significantly prolong life for some patients, but for other patients it may not. Aggressive treatment can have bad side effects, so the more certain a doctor can be that it’s the right choice, the better. In this study, researchers were able to pinpoint characteristics of a patient that could be used to identify which patients might benefit from aggressive treatment and which patients might be better off with less-aggressive treatment. Further studies are needed to refine these factors.

“A large, international analysis of patients with stage IV non-small cell lung cancer (NSCLC) indicates that a patient’s overall survival (OS) rate can be related to factors including the timing of when metastases develop and lymph node involvement, and that aggressive treatment for “low-risk” patients leads to a five-year OS rate of 47.8 percent, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.

“When lung cancer has spread from an original tumor to other sites of the body, it is classified as metastatic (Stage IV), and the goal of treatment is to slow the cancer down with chemotherapy or radiation, but these treatments are unable to eradicate the cancer and survival is usually in the range of only a few months.

“However, when there are only a few locations of metastatic lung cancer (called oligo-metastatic), some studies suggest that by removing or eradicating each of those cancer deposits with aggressive treatments such as surgery or high-dose, precise radiation called stereotactic ablative radiotherapy or SABR, the cancer may be controlled for a long period of time…

” ‘Our study finds some stage IV NSCLC patients can achieve long-term survival after aggressive treatments; however, it is important to note that the patients in this study are a very select minority of stage IV patients who are younger, more physically fit, with a lower burden and slower pace of disease than the average stage IV patient,’ said lead study author Allison Ashworth, MD, a radiation oncologist who completed the study as part of her training at the London Health Sciences Centre at Western University, in London, Ontario. ‘We hope our study’s results will help determine which stage IV NSCLC patients are most likely to benefit from aggressive treatments, and equally as important, help identify those patients most likely to fail, thus sparing them from futile and potentially harmful treatments. Our research, however, cannot answer the question of whether the longer survival is due to the treatments or simply because these patients have less aggressive disease. We must await the results of randomized clinical trials to answer this question. In the meantime, it is our hope that our study will help cancer specialists in making treatment decisions and in the development of clinical trials. ‘”

Local Radiotherapy May Allow Lung Cancer Patients to Stay on Xalkori Longer

Crizotinib (Xalkori) is effective for patients with non-small cell lung cancer (NSCLC) who have a mutation in the ALK gene, but their cancer usually develops resistance to the drug. However, this resistance may affect only part of the cancer, while the majority of the disease still responds to Xalkori. In such cases, localized radiation may be used to destroy the resistant part of the cancer (a technique dubbed ‘weeding the garden’) while patients continue to take Xalkori. In a small study, patients treated with this method could take Xalkori almost three times longer than those not eligible for the treatment. Longer times on Xalkori were associated with higher rates of 2-year survival. The average time without further relapse after the first radiation treatment was 5.5 months, and patients could be treated multiple times. Similar approaches may be effective with other targeted therapies.

Radiation Therapy Can Treat Suspected Lung Cancer Without Biopsy

Some patients with suspected lung cancer cannot undergo a biopsy due to other illnesses or overall frailty; for others, biopsies are performed, but with inconclusive results. For these patients, the diagnosis of lung cancer often rests on strong evidence from computed tomography (CT) or positron emission tomography (PET) scans. In many of these cases, lung cancer also cannot be treated with surgery. A recent study confirms radiation therapy as a safe and effective method for controlling lung cancer in such patients. Thirty-four patients with unbiopsied lung cancer received stereotaxic body radiation therapy (SBRT). Tumors stopped growing in all patients but 1, shrank in 7 patients, and disappeared entirely in 8 of them. No severe side effects were observed. Another study demonstrated that SBRT, in which focused, high doses of radiation are given over a relatively small number of sessions, is more effective against inoperable non-small cell lung cancer (NSCLC) than traditional, conventionally fractioned radiotherapy (CFR).

FDG-PET Distinguishes Low- and High-Risk Lung Cancer Patients After Radiotherapy

Fluorodeoxyglucose-positron emission tomography (FDG-PET) scans may be able to detect early-stage non-small cell lung cancer (NSCLC) patients who are at high risk of treatment failure after stereotactic body radiation therapy (SBRT). A retrospective study examined patients with early-stage NSCLC who were ineligible for or refused surgery and were instead treated with SBRT. Patients with lower FDG-PET readings prior to SBRT treatment survived longer, and those whose FDG-PET readings changed more after SBRT were less likely to experience treatment failure. FDG-PET scans may therefore help identify which patients are at lower or higher risk of recurrence; high-risk patients may opt for additional treatment and/or more frequent surveillance after treatment. FDG-PET has shown similar predictive value in early-stage NSCLC treated with surgery.

Stereotactic Ablative Radiotherapy May Be Effective Option in Multiple Primary Lung Cancer

A significant number of lung cancer patients develop more than one primary tumor. The tumors arise independently and are not cases of one original tumor spreading to other sites or recurring after removal. This condition, known as multiple primary lung cancer (MPLC), is often treated surgically. However, not all patients are eligible for surgery. A recent study retroactively examined the records of patients with early-stage MPLC who had been treated with stereotactic ablative radiotherapy (SABR), a form of radiotherapy that uses high radiation doses over relatively few sessions, instead of surgery. Patients experienced good tumor control rates, and almost half survived for 4 years or more. SABR may be an effective treatment option for patients with inoperable MPLC.