Photo Credit: Valerii Apetroaiei
“This technology gives us the ability to be more precise and personalized to each patient,” says Percy Lee, MD.
High doses of radiation, along with stereotactic ablative radiotherapy (SABR) and chemotherapy, is a safe and effective personalized treatment for people with non-resectable locally advanced non-small cell lung cancer (NSCLC), results of a small clinical trial suggest.
“In this nonrandomized controlled trial, patients in the intermediate-dose cohort, treated with 70 Gy in 15 fractions with an adaptive SABR boost and concurrent platinum-based chemotherapy, achieved excellent LC [local control] without severe acute or late grade 3 or higher toxic effects at a median follow-up of 3.5 years,” senior study author Percy Lee, MD, and colleagues write in JAMA Oncology.
In the early-phase dose escalation trial, Dr. Lee and colleagues investigated the highest personalized boost dose that would be safe when combined with chemotherapy in 28 patients treated for nonresectable stage II or III NSCLC at one academic medical center between 2011 and 2018. Participants ranged in age from 51 to 88 years, and 16 (57%) were male.
Healthcare providers treated all patients with 4 Gy × 10 fractions followed by an adaptive SABR boost to target residual metabolically active cancer. The boost consisted of an additional 25 Gy for ten patients in the low-dose group (5 Gy × 5 fractions), 30 Gy for nine patients in the intermediate-dose group (6 Gy × 5 fractions), or 35 Gy for nine patients in the high-dose group (7 Gy × 5 fractions). All participants also received concurrent weekly carboplatin and paclitaxel chemotherapy.
Two-year local control rates were 74.1%, 85.7%, and 100.0% for the low-, intermediate-, and high-dose groups, respectively, and two-year overall survival rates were 30.0%, 76.2%, and 55.6% for the low-, intermediate-, and high-dose groups, respectively.
Most patients experienced mild side effects, including fatigue, sore throat, or cough, and two deaths occurred in the high-dose group.
Physician’s Weekly (PW) spoke with Dr. Lee, who, during the study, was a professor of oncology at UCLA and is now Vice Chair of Clinical Research in the Department of Radiation Oncology at City of Hope.
PW: What motivated you to conduct this study?
Dr. Lee: For patients with stage III NSCLC who are not treated with surgery, the standard of care is chemotherapy with radiation over six weeks. Afterward, patients are treated with durvalumab immunotherapy. When the study was conceived, the standard of care was chemotherapy and radiation. I was trying to cut down the treatment from six weeks to three. We designed the study as a dose escalation, much like a drug trial, that asked how high we can safely and effectively boost radiation doses. We found that three weeks of dose-escalated radiation for stage III lung cancer appears to be safe and to have better local and regional disease control.
How may your findings improve patient care?
This technology gives us the ability to be more precise and personalized to each patient, enabling better disease control, shorter treatment time frames, lower costs, and better outcomes. Stage III lung cancer patients are a very heterogeneous population, so we shouldn’t use a one-size-fits-all approach.
What should clinicians consider when they advise their patients with lung cancer?
Patients diagnosed with lung cancers, particularly advanced cancers, had been getting pessimistic advice from providers. But that’s not the case anymore due to the availability of immunotherapy. We still hear from patients who’ve been told that undergoing radiation in an advanced cancer treatment center is not worth doing because it doesn’t matter. But it does matter. Technology matters. Expertise matters. If I had a family member with lung cancer, I would want them to be treated by an expert team at a specialized cancer center.
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