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Latest Research in Lung Cancer

Across the world, radiation oncologists are actively researching safe and effective radiation treatments, including more personalized approaches and studies of lower doses for a variety of cancers. The following research studies were presented during the ASTRO Annual Meeting in Chicago in September 2019. Annually, ASTRO brings together more than 10,000 radiation oncology professionals to share the latest science and provide educational sessions, all designed to improve patient care, support clinical practice and advance science and research in the field of radiation oncology.

It is important to review and discuss all treatment options, including radiation therapy with your primary care physician before determining which option or combination of options is best for you and your lifestyle.

Studies in Lung Cancer

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New radiation treatment plans for lung cancer

Can some lung cancer patients improve their prognoses by receiving extra radiation treatments over a shorter time than usual, without suffering additional side effects from the treatment? A recent study is cautiously optimistic, though the researchers warn that the technique needs to be studied further and in combination with other treatments.

Conducted at UCLA, the study evaluated 28 patients on a prospective Phase II study with inoperable non-small cell lung cancer that was locally advanced and gave them an accelerated course of radiation and chemotherapy, further “boosted” by targeted radiation treatments using stereotactic ablative radiotherapy, or SABR.

The current standard of care for patients with locally advanced non-small cell lung cancer is chemotherapy at the same time as radiation therapy for six weeks, said lead author Percy Lee, MD, a radiation oncologist who specializes in SABR. “Outcomes for this treatment plan are suboptimal, with poor cancer control and long-term survival,” he said. The study sought to answer several questions: whether higher doses of radiation, over three weeks, would be more effective than the current standard; how much radiation patients could tolerate without harmful reactions; and whether an extra “boost” of SABR radiation would improve patients’ survival rates.

The three-week regimen appeared to be safe and effective for many of the patients, though Dr. Lee did note that two patients out of 28 treated had fatal complications from the treatment. The patients’ overall survival rates were 78% at one year and 52% at two years. He said the advantage of using SABR as part of the treatment was that it minimizes high doses of radiation to normal tissues, including the heart, spinal cord, esophagus and airways.

However, Dr. Lee said this work is only the beginning of finding ways to combine SABR with other kinds of treatment. “With advances in radiation therapy planning and delivery, along with advances in systemic therapy with immunotherapy, we are seeing more favorable results and achieving higher rates of durable disease control and cure,” he said. “We believe that this abbreviated and dose-intense plan for chemoradiotherapy should be studied in combination with immunotherapy to see if we can further enhance disease control, survival and quality of life in these patients.”

Radiation therapy may increase immunotherapy results in patients with advanced lung cancer

When cancer patients have a widespread, or systemic, response to a localized therapy (for example, after radiation to one site of cancer leads to all sites of cancer shrinking), this is called the abscopal effect. Radiation oncologists are trying to better understand the abscopal effect in hopes of being able to trigger this response in patients more consistently. In that way, more patients could have better-than-expected responses to treatment, eventually improving the standard of care.

Allison Campbell, MD, PhD, of Yale University, and colleagues recently conducted a Phase II trial to study the abscopal effect in patients with metastatic lung cancer. “Our clinical trial enrolled patients with metastatic lung cancer who had their disease progress while undergoing immunotherapy,” she said. “We gave them radiation to just one cancerous lesion in the hopes that this would stimulate an anti-tumor immune response throughout the whole body.”

The researchers enrolled 50 patients with metastatic lung cancer who had not yet received immunotherapy and treated them with the drug pembrolizumab. Of these 50 patients, disease progressed in 16. These patients, plus six others whose cancer had already progressed on immunotherapy, received high-dose stereotactic body radiation therapy (SBRT) to a single tumor each. The patients who received SBRT experienced an average of five months before their cancer progressed. And nearly half of the SBRT patients achieved stable disease after treatment.

The researchers also found that 10% of patients in the study had tumors shrink that were located outside the area that received radiation. What’s more, this response continued for more than a year in some patients. 

This study, in combination with other recently published Phase I/II trials, indicates that the combination of immunotherapy and radiation is safe. “There are hints that adding radiotherapy to immunotherapy might emerge as an important therapeutic option when immunotherapy stops working,” Dr. Campbell said.