Good Results With Stereotactic Body Radiation Therapy Plus Erlotinib in Limited but Progressive Metastatic NSCLC
In a phase II study reported in the Journal of Clinical Oncology, Iyengar et al found that stereotactic body radiation therapy plus erlotinib (Tarceva) resulted in infrequent recurrence in radiation therapy–treated sites and was associated with prolonged progression-free survival and overall survival in patients with limited but progressive metastatic non–small cell lung cancer (NSCLC).
Study Details
In the study, 24 patients (13 men, 11 women; median age 67 years) with stage IV NSCLC and six or fewer sites of extracranial disease who had disease progression on platinum-based chemotherapy received stereotactic body radiation therapy with concurrent erlotinib until disease progression. Stereotactic body radiation therapy with equipotent fractionation was delivered to all disease sites after the start of erlotinib.
A total of 52 sites were treated with stereotactic body radiation therapy, with 16 of the 24 patients receiving radiation to more than one site. The most common treated sites were lung parenchyma (35%), mediastinum/hilum (25%), adrenals (13%), and bone/spine/chest wall (13%). None of 13 patients tested had EGFR mutation.
Outcomes
Median progression-free survival was 14.7 months, and median overall survival was 20.4 months. Of the 24 patients, 13 had greater than 6-month follow-up without disease progression; of the 11 with less than 6-month follow-up, 6 had progression. Most patients had progression at new distant sites, with only three local stereotactic body radiation therapy failures being observed among 47 evaluable lesions.
Among 21 patients, 3 had failure only in one of their radiation fields, 10 had failure at new distant sites outside radiation fields, and 10 had no recurrence at last follow-up. Three patients had four recurrences outside original radiation fields and continued to receive study treatment. New sites of recurrence in these patients included hilum in two cases, thoracic spine, and liver. Progression-free survival after the second round of stereotactic body radiation therapy was 6 to 9 months.
Two grade 3 toxicities (pneumonitis and back pain from vertebral compression fracture) were considered related to stereotactic body radiation therapy.
The investigators concluded: “Use of [stereotactic body radiation therapy] with erlotinib for unselected patients with stage IV NSCLC as a second- or subsequent line therapy resulted in dramatic changes in patterns of failure, was well tolerated, and resulted in high [progression-free survival] and [overall survival], substantially greater than historical values for patients who only received systemic agents.”
Robert Timmerman, MD, of University of Texas Southwestern Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by OSI Pharmaceuticals. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
