Local therapies for metastatic NSCLC while on Osmirtinib

Hi Garth,

I'm not on the panel but I think I can help.  These types of radiation are often employed for liver metastases but not usually in other parts of the body where you normally find lung mets.  I imagine the panelists didn't leave them out on purpose but more of an oversite since it's pretty specific use in the liver.  For the type of progression where local therapy works well (as in what you've described), it doesn't really matter what type of treatment but whether it's a good match for the type and placement of the target. Are you leaning towards sirt treatments for the liver met?  

I hope you do well with your treatment.

All best,

Janine

Radiation approaches like standard “3D-conformal radiation” or proton beam are not as commonly used for liver lesions as the approaches you mentioned, which are more frequently used for brain, lung, or bone lesions, though a radiation oncologist would need to speak to the relative strength of these techniques over SIRT (selective internal radiation therapy) or RFA (radio frequency ablation) for a liver lesion, which are more frequently used options for the liver.  

Protons are newer, and protons are heavily marketed, but there is no clinical evidence showing that protons are better in metastatic lung cancer or prostate cancer or breast cancer or nearly all other adult cancers. Dr. Mehta made the point that protons have the potential to be better, but they don’t have enough sophisticated software support and experience to show that right now.  Protons are a bit like having a very expensive, fancy new phone with its own operating system, but there are still very few apps for it. That’s not clearly better than the current standard with a ton of apps and users and far more experience. Moreover, it’s not clearly the case that you can actually do more and do things better than with a good current phone and lots of apps and experience. Protons are like talking about the amazing technical specs of a phone, which is something easy to market, but does it actually lead to a better experience? Marketing of protons is based on the innuendo of what it might be able to do, but people marketing protons can’t highlight the better results, because there are no demonstrated better results in any common adult cancer.  And there’s a lot of marketing because it costs a ton to make a proton facility, so you need to market protons heavily to consumers, hoping they’ll be gullible enough to not ask for clinical evidence, because proton beam therapy evidence doesn’t sell itself...

This isn’t to say that proton beam therapy is inferior. It’s certainly comparably good, but in the absence of evidence to show it’s better, it is just a far more expensive platform that should be presumed to be no better than standard radiation. Dr. Mehta made the point that it may prove to be better in the future, and with time the technology is also likely to be more cost effective. In this respect, it’s like saying that the price of a new phone and operating system need to come down, and we need more time, before it becomes common enough to have the users and apps to make it attractive and broadly useful.

Good luck.

-Dr. West

Hi Garth,

Glad you were able to have good conversations with your doctors and develop a solid plan for treatment. Good luck, and we look forward to a positive status report filled with good news!

Jim C Forum Moderator 

Hi Garth,

I know you're in good hands at MSK and look forward to hearing about good results.

Janine

Who knew restless leg could come in so handy:); that is if you preferred to be out during the procedure.  I'm glad the IR is happy with the way it went.

I look forward to hearing that the treatment killed the tumor and that this is just a bump in the road to a long run on tagrisso.

Hoping for the best!

Janine

Glad to hear that the procedure went well, aside from the restless leg problem. As Janine said, I hope this smooths over this bump in the road and it's clear sailing on Tagrisso!

We'll look forward to your next good-news update.

Jim C Forum Moderator