“Our hypothesis was that aggressive local therapy — radiation or surgery — would improve progression-free survival, and it did”, said Daniel Gomez, M.D., Associate Medical Director of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. The procedure would be applicable to patients with stage IV lung cancer whose disease has spread to a limited number of sites.
“We found that adding radiation or surgery to target all sites of disease increases the time it takes for the cancer to return or spread, and it also improves overall survival time. But the overall survival results were more impressive than anticipated”.
In the United States, lung cancer is the second leading cause of death, responsible for one out of every ten mortalities. Advanced cases of non-small-cell lung cancer (NSCLC) have a particularly poor prognosis, due in part to the aggressive nature of the disease and its relenting progression even under treatment.
A clinical trial was conducted with patients from three hospitals (MD Anderson Cancer Center, London Health Sciences Center and the University of Colorado). They all received systemic therapy consisting of either four or more cycles of standard chemotherapy (platinum doublet therapy) or three or more months of drugs that target tumor blood vessel growth (EGFR, or ALK inhibitors for EGFR mutations/ALK rearrangements). Those showing no disease progression were randomized into two groups, one was the experimental arm and received surgery or radiation therapy, the other was the control and had standard systemic maintenance therapy.
Overall, the differences between the two groups were more than significant. Those in the experimental arm experienced a progression-free survival benefit of 14.2 months, compared to 4.4 months for the control. Survival rates were even more dramatic, 41.2 months average for the first group, as opposed to 17.0 months with the observation one.
“In patients with limited metastases, our study demonstrates that there is a role for more aggressive treatment,” concluded Dr. Gomez. “Exploratory analyses suggest that aggressively treating all disease sites at the time of progression improved outcomes for these patients, compared to patients who did not receive late local therapy. Thus, there may be a benefit to either early or late radiation/surgery in the setting of limited metastatic disease”.
These finding will hopefully lead to a reassessment of what is now considered standard treatment and improved practices that can extend survival for all cancer patients.