The results of a recent clinical trial published in the Journal of Clinical Oncology in patients with stage IV non small cell lung caner (NSCLC) suggest that combining stereotactic body radiation therapy (SBRT) with Tarceva (erlotinib) chemotherapy significantly improve survival.

Lung cancer remains the leading cause of cancer death in the United States and abroad, highlighting the importance of finding more effective approaches to treatment. In the United States, NSCLC accounts for 75–80% of all lung cancers. Although progress has been made in recent years the majority of patients with advanced stage lung cancer still die from their disease. New treatments are sorely needed.

As cancer research has evolved, it has become increasingly clear that the specific characteristics of the cancer can have a profound effect on the behavior of the cancer and its response to specific treatments. In NSCLC, mutations in the EGFR gene may influence whether the cancer responds to the EGFR-targeted drug Tarceva. Among patients with advanced NSCLC that test positive for a mutation in the EGFR gene, initial treatment with the targeted therapy Tarceva produces better outcomes and fewer serious side effects than chemotherapy.  These EGFR targeted therapies have become the standard of care in NSCLC patients that are EGFR positive, however resistance to these targeted treatments still occurs over time and new treatment options are needed.

SBRT is a newer type of radiation therapy pioneered in the management of brain cancer in which very high doses of radiation therapy are delivered from multiple angles to treat cancers that are well defined. The goal is to deliver a radiation dose high enough to kill the cancer, while minimizing exposure to surrounding healthy tissue and organs,

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In the current clinical trial 24 patients with stage IV NSCLC whose cancer has continued to spread during their initial therapy were treated with SBRT and Tarceva.  The combination resulted in an average overall survival of 20.4 months, which compares quite favorably to the 6- to 9-month overall survival attained historically among patients treated with Tarceva alone. The combination also delayed the time to cancer progression to an average of 14.7 months compared to 2 to 4 months for similarly selected lung cancer patients.

Currently radiation therapy is not typically used to treat advanced NSCLC.  This study suggests however that there may be a role for SBRT in the management of advanced NSCLC when the cancer is well defined and can be targeted with the radiation. Patients with advanced NSCLC should discuss the potential role of SBRT with their treating physician as well as that of clinical trials evaluating new and novel treatment techniques.

Reference: Iyengar P, Kavanagh B, WArdak Z, et al. Phase II Trial of Stereotactic Body Radiation Therapy Combined With Erlotinib for Patients With Limited but Progressive Metastatic Non–Small-Cell Lung Cancer. Journal of Clin Oncol. Published online before print October 27, 2014, doi: 10.1200/JCO.2014.56.7412

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