Radiation, chemo combo improves survival for advanced-stage NSCLC patients

According to data from a Phase II trial presented at ASTRO today, combining radiation therapy and chemotherapy could help curb disease progression for patients with limited metastatic non-small cell lung cancer.

Progression-free survival went from 3.5 months to 9.7 months when patients were treated with the addition of radiation therapy at all the metastatic sites of lung cancer, as well as the primary disease site. Side effects related to treatment were similar between the groups receiving the combination therapy and those treated with just chemotherapy, the researchers reported.

“Even in the era of immunotherapy, there are not large numbers of metastatic NSCLC patients with durable responses to systemic therapy. In our trial, however, the addition of radiation therapy directed at each of the cancerous areas greatly improved how patients responded to subsequent rounds of chemotherapy,” lead author Dr. Puneeth Iyengar said in prepared remarks. “This finding suggests that local treatments, including radiation, could work in concert with chemotherapy to prolong the amount of time before recurrence occurs in patients with limited sites of metastatic NSCLC.”

The Phase II trial, which enrolled 29 patients, evaluated whether the addition of local consolidative radiation therapy to the standard treatment of systemic therapy boosts progression-free survival for patients with limited metastatic NSCLC.

Patients were randomized to receive maintenance chemotherapy alone or a combination of stereotactic ablative radiotherapy to all sites of the disease followed by maintenance chemotherapy.

An interim analysis showed a median progression-free survival rate of 9.7 months with consolidative radiation therapy followed by chemotherapy, compared to 3.5 months for maintenance chemotherapy alone.

“These findings verify that progression-free survival for limited metastatic disease really is no different than it is for widely metastatic disease, suggesting that local therapy could play an important future role in survival outcomes,” Iyengar added. “Moreover, the addition of consolidative radiation did not increase toxicity, which allowed patients to continue on to additional systemic therapy that is important to controlling aggressive metastatic disease.
“There is a significant possibility that local therapy, such as consolidative radiation, may become an important part of the management of limited metastatic NSCLC patients, but this validation must take place in randomized phase III studies. Interested patients should seek more information about the ongoing NRG LU 002 and Saron trials.”