Consolidative Radiotherapy Prior to Chemotherapy for Limited Metastatic NSCLC
In patients with limited metastatic non–small cell lung cancer (NSCLC; primary plus up to five sites), Puneeth Iyengar, MD, PhD, of the Harold C. Simmons Comprehensive Cancer Center at The University of Texas Southwestern Medical Center, Dallas, and colleagues, writing in JAMA Oncology, found that intervening with noninvasive stereotactic ablative radiotherapy before maintenance chemotherapy but after induction therapy resulted in significant gains in progression-free survival. These findings were also presented recently at the 2017 Annual Meeting of the American Society for Radiation Oncology (ASTRO).
“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,” revealed Dr. Iyengar in an ASTRO press release.
A total of 29 patients took part in this study, with half receiving stereotactic ablative radiotherapy plus maintenance chemotherapy and half receiving maintenance chemotherapy alone. Maintenance chemotherapy consisted of pemetrexed, docetaxel, erlotinib, or gemcitabine.
An improvement in progression-free survival from 3.5 to 9.7 months was observed in those who received consolidative radiotherapy and maintenance chemotherapy, at an interim analysis. In fact, the trial was stopped to accrual early after these interim results were observed.
It was also noted that the added radiation did not appear to increase toxicity. Thus, patients were able to continue with the added systemic therapy needed to control their metastatic disease. A larger, randomized phase III trial is planned to assess survival outcomes.