My daughter has Stage IV NSCLC with the ROS1 mutation. After 4 rounds (3 months) of chemotherapy the cancer has progressed so the oncologist has switched therapy to Crizotinib. We are continuously checking clinical trials. One trial uses Stereotactic Body Radiation Therapy on patients receiving this targeted therapy. We are not sure she is eligible for this trial but are wondering what a Radiation Oncologist opinion on combining Radiation with Crizotinib. Also we have read about the Accuray CyberKnife M6 System with InCise2 technology. Her major tumors are in the lung and the liver.
1. Has combining radiation with targeted therapy shown to improve the outcome?
2. These two methods are new and very precise -- is there any data or publications on either or both methods?
3. Is there any problem with radiation of the liver?
Thank you for your support and information.
Reply # - April 4, 2016, 08:22 AM
Hi Teddy,
Hi Teddy,
I'm sorry to hear there has been progression, bit I'm hopeful that crizotinib will be very effective, with the presence of tha ALK rearrangement.
Typically, with stage IV lung cancer distant metastases are not treated with local therapies such as surgery or radiation except to palliate symptoms, because cancer cells have reached the bloodstream and are likely to pop up elsewhere. At times, if there are just one or two mets and the cancer is responding well to treatment, an exception will be made for such oligometastases. You have stated that the "major" tumors are in the lung and liver; if there are other distant metastases, radiation becomes a less attractive option.
Unless there are special circumstances with regard to the liver met, the "latest and greatest" SBRT technologies such as those you mention are likely not necessary; you'd need to discuss that with your radiation oncologist.
Radiation can have side effects such as pain and gastrointestinal difficulties; that's one of the reasons it's not favored for metastatic lung cancer.
Good luck with crizotinib.
JimC
Forum moderator