Expert Point of View: Roy S. Herbst, MD, PhD

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This study should be placed in the context of treating to cure, said Roy S. Herbst, MD, PhD, Ensign Professor of Medicine and Chief of Medical Oncology at Yale University School of Medicine, New Haven, Connecticut. “If we can further increase the cure rate in stage III non–small cell lung cancer (NSCLC), that would be a major advance. Some earlier studies suggested that higher doses of radiation would improve outcomes but would lead to higher toxicity despite improved techniques. The surprising negative finding for higher-dose radiation in this study suggests that not only is it not better than low-dose radiation, but in fact it leads to worse outcomes. More is not always better.” Dr. Herbst commented.

“The fact that an increased dose of radiation does not appear to improve survival does not preclude the benefits of higher doses of radiation with other new radiation techniques, but demonstrating that would require new randomized controlled trials,” he added.

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“For now, this study answers the question to my satisfaction. More standard doses of radiation are adequate for treatment of stage III NSCLC,” Dr. Herbst stated.

He is eagerly awaiting final results of the cetuximab comparison in this study. “Previous studies suggested that cetuximab holds promise in the treatment of NSCLC,” he noted.

Dr. Herbst is also lead investigator of the Southwest Oncology Group (SWOG) 0819 trial, which is evaluating chemotherapy with or without cetuximab in patients with metastatic stage IV NSCLC. In that study, tissue samples were obtained for biomarker analysis, and epidermal growth factor receptor (EGFR) status will be determined by fluorescence in situ hybridization gene copy number analysis or H-score based on immunohistochemistry. This will hopefully determine whether EGFR is a predictive marker for benefit of cetuximab in this group of patients, he said. ■

Disclosure: Dr. Herbst reported no potential conflicts of interest.

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