Standard-of-care chemoradiation superior to two alternatives for Stage III NSCLC
Researchers have investigated the impact of increasing the radiation dose in the current standard-of-care chemoradiation regimen for Stage III, non-small-cell lung cancer patients (NSCLC). The results suggest the current standard chemoradiation dose is superior to two alternative regimens.
For individuals with locally advanced, Stage III, non-small-cell lung cancer (NSCLC), the current standard-of-care treatment regimen is chemoradiation – a combination of chemotherapy and radiotherapy. In this study, researchers from the Winship Cancer Institute at Emory University (GA, USA) investigated whether a higher radiation dose would be more effective at killing cancerous cells, versus the standard dose. The results of the study suggest that the current standard-of-care chemoradiation regimen is superior to a regimen involving either a higher radiation dose or including the drug cetuximab into the protocol.
In the USA, lung cancer represents the leading cause of cancer death; 75–80% of lung cancer cases are NSCLC. The majority of research into therapy regimens for locally advanced NSCLC has focused on identifying the most effective and efficacious chemotherapy drugs to be used in chemoradiation, and how to properly integrate these with radiotherapy. The optimization of the radiation component of chemoradiation has received less attention.
In this study, researchers employed a 2x2 factorial trial design and estimated the 5-year, overall survival rates of 496 patients with locally advanced, Stage III NSCLC to investigate whether increasing the radiation dose from the standard 60Gy (SI: J/Kg) to 74Gy, or adding the drug cetuximab into the regimen, would improve the effectiveness of standard-of-care chemoradiation.
For individuals receiving chemoradiation with a standard radiation dose, with or without cetuximab, the estimated 5-year survival rate was 32.1%. By contrast, the survival rate for individuals receiving high-dose radiation as part of their chemoradiation was 23%. Further, the progression-free survival rates for individuals receiving standard- versus high-dose radiation were 18.3% and 13% respectively.
Lead study author Jeffrey Bradley (AstraZeneca; Cambridge, UK) commented: “This is amongst the highest overall survival results of any Phase III trial for patients with Stage III NSCLC. These results argue strongly that the current standard-of-care radiation dose should be 60Gy…The use of cetuximab confers no survival benefit at the expense of increased toxicity.”
Bradley JD, Hu C, Komaki RR et al. Long-term results of NRG Oncology RTOG 0617: standard- versus high-dose chemoradiotherapy with or without cetuximab for unresectable Stage III non-small-cell lung cancer. J. Clin. Oncol. doi:10.1200/JCO.19.01162 (2019) (Epub ahead of print);