GRACE :: Lung Cancer

Unresectable locally advanced NSCLC

Options and controversy around management options for unresectable stage IIIA and IIIB NSCLC

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High vs. Standard Dose Chest Radiation in Stage III Lung Cancer

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GRACE Cancer Video Library - Lung

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Dr. Jeffrey Bradley, Radiation Oncologist at Washington University in St. Louis, provides trial evidence showing that patients may not benefit from high dose chest radiation therapy vs. standard dose therapy.

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Transcript

This is a topic I’ve been a little passionate about over the past ten years or so. We published a paper in Lancet Oncology this past February, it was RTOG 0617, and it was a comparison of high dose radiation therapy, 74 Gy, versus standard dose radiation, 60 Gy, in patients with stage III non-small cell lung cancer. They were unresectable, they received either the high dose or standard dose of radiation, and they were further randomized to receive cetuximab or not; cetuximab is an EGFR antibody.

The trial was published — it didn’t show an advantage to high dose radiation therapy, in fact, it shows a disadvantage to high dose radiation therapy. The median survival of the patients that were treated with 60 Gy without cetuximab was 28 months, compared to 20 months for patients receiving high dose radiation therapy. It turns out, even though we used the most sophisticated treatment techniques at the time, perhaps normal tissue doses were the cause of the high dose arm failing to achieve a better outcome, and a poor outcome in fact. We look at this as the heart dose — it turned out to be very important. We didn’t place heart dose constraints because, at the time, no one was placing heart dose constraints, and now we find out that’s very important. So, our subsequent trials have included heart dose constraints going forward, within, at least, the Energy Oncology Cooperative Group.

Likewise, there was no advantage to cetuximab in this patient population. These patients were unselected for EGFR status, and there’s an indication from the paper that if you look for EGFR status, people who had a high H-score may have benefitted from that drug. Nevertheless, there was no distinct survival advantage to receive cetuximab.

So the standard of care nowadays is 60 Gy with concurrent chemotherapy  — in that trial we used weekly paclitaxel and carboplatinum. We also used two cycles of consolidative chemotherapy in that study.


Dr West

Core Principles of Managing Locally Advanced (Stage III) NSCLC

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Here’s a text-heavy but still brief summary “slidedoc” of what I would consider to be the core principles of managing locally advanced, or stage III, non-small cell lung cancer (NSCLC). This is a heterogeneous population that accounts for about 40% of the patients newly diagnosed with NSCLC, with some having far more extensive and bulky disease than others.  Though individual treatment recommendations should be made by the physicians directly reviewing the details of a patient’s case, the key principles still govern the overall plan.

 

 

The hyperlinks are to this earlier Slidedoc: http://www.slideshare.net/JackWestMD/treating-invisible-disease-grace

And here’s the printable pdf file of the slides: Core Principles of Managing Locally Advanced NSCLC

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Dr West

ASCO Lung Cancer Highlights, Part 6: Predicting Benefit of Chemotherapy vs. EGFR Inhibitor Therapy in Second Line by Dr. David Gerber

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Dramatic benefit from EGFR inhibition in lung cancer with EGFR mutationsDr. David Gerber, University of Texas-Southwestern, reviews the results of the PROSE study of the Veristrat serum proteomics test to predict benefit of chemo or EGFR inhibitor for second line treatment of advanced lung cancer.

 

ASCO Lung Cancer Highlights, Part 6: Predicting Benefit of Chemotherapy vs. EGFR Inhibitor Therapy in Second Line Audio Podcast


Dr West

ASCO Lung Cancer Highlights, Part 5: Updates in Maintenance Therapy for Advanced NSCLC by Dr. David Gerber

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The PointBreak TrialDr. David Gerber, University of Texas-Southwestern, discusses results of two important trials of maintenance therapy in advanced NSCLC, including the PRONOUNCE trial and POINTBREAK trials.

 

ASCO Lung Cancer Highlights, Part 5: Updates in Maintenance Therapy for Advanced NSCLC Audio Podcast


Dr West

ASCO Lung Cancer Highlights, Part 4: Exploring the Role of Trimodality Therapy for Stage III NSCLC by Dr. David Gerber

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The Swiss SAKK 16/00 (IIIA/pN2 NSCLC) trial addressed this questionDr. David Gerber, University of Texas-Southwestern, reviews a Swiss study comparing tri-modality therapy with chemoradiation followed by surgery to chemo followed by surgery for stage IIIA NSCLC.

ASCO Lung Cancer Highlights, Part 4: Exploring the Role of Trimodality Therapy for Stage III NSCLC Audio Podcast


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