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.
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).
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.
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.
Stereotactic body radiation therapy (SBRT), a type of radiotherapy that uses high doses of radiation given over a comparatively small number of sessions, is the treatment of choice for patients with stage I non-small cell lung cancer (NSCLC) who cannot undergo surgery because of other medical problems. However, until now the use of SBRT for these patients was based on limited evidence. A systematic study spanning several institutes found that SBRT (sometimes also called stereotactic ablative radiotherapy or SABR) for stage I NSCLC was safe and effective. Higher radiation doses were associated with better outcomes.
Researchers have constructed a model to assess the cost-effectiveness of different treatments for stage I non-small cell lung cancer (NSCLC) based on treatment costs, predicted life expectancy, and expected quality of life. Model simulations indicate that lobectomy (removal of an entire subsection of the lungs) is the most cost-effective treatment for patients whose cancer is clearly operable. For patients who are only borderline eligible for surgery due to poor health (‘marginally operable’), who often cannot withstand lobectomy, a type of radiotherapy called stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), was found to be more cost-effective than wedge resection (removal of a small piece of lung containing the cancer).
A recent study found stereotactic ablative radiotherapy (SABR) to be safe and effective for non-small cell lung cancer (NSCLC) treatment, offering better tumor control, lower toxicity, and greater convenience than conventional radiation therapy. The retrospective study focused on patients with NSCLC who could not be treated with surgery. Outcomes were especially beneficial for tumors that were smaller and had lower metabolism (measured by sugar absorption rate). SABR, also called stereotactic body radiation therapy (SBRT), uses higher doses of radiation over a smaller number of sessions compared to conventional radiation therapy.
Results of a clinical trial that evaluated the prostate cancer vaccine Provenge have come under scrutiny. Questions arise regarding the reported 4-month survival benefit that ultimately led to FDA approval. Disputers suggest that a flaw in methods led to the survival benefit, but that the vaccine may actually cause harm.
A recent study evaluated the usefulness of surgery versus observation to treat localized prostate cancer. In the study, 731 men were followed for 10 years. Those treated with surgery did not have a significant decreased risk of death compared to those who were observed for advancing cancer.