Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Clinical Trial Focus: RADIANT Trial in Adjuvant NSCLC

Please Note: New Treatments Have Emerged Since this Original Post
Author
Howard (Jack) West, MD

As described in a prior post, chemotherapy after surgery is often recommended after surgery, at least for a subset of patients with stage IB to IIIA (without mediastinal lymph node involvement) NSCLC, based on a potential to increase cure long-term survival compared to surgery alone. At this point, two forms of targeted therapy (erlotinib, or Tarceva, as a single agent in second- and third-line advanced NSCLC, and bevacizumab, or Avastin, combined with carboplatin and paclitaxel for first-line treatment of advanced NSCLC) have been approved by the FDA for advanced NSCLC because they have demonstrated an improvement in survival. At this point, however, we don't know whether adding targeted therapies as a strategy in earlier stage NSCLC can increase cure rates. But one key trial that is evaluating this possibility is the RADIANT trial.

radiant-trial.jpg RADIANT Trial; click to enlarge.

RADIANT is an acronym for Randomized, Double-Blind Trial in Adjuvant NSCLC with Tarceva. This will be an international trial designed to enroll 945 patients who have undergone surgery, with no residual cancer left behind, for stage IB, II, or stage IIIA NSCLC. Patients may have received up to four cycles of chemotherapy after surgery, but patients who received no chemo are still eligible. Patients are then randomized to receive either tarceva or a placebo, with two-thirds of patients receiving the active drug and one-third receiving placebo. Because it is a double-blinded study, neither patients nor their treating doctor know who is getting tarceva or a placebo. This is appropriate because we don't know whether Tarceva is going to be better, the same, or actually worse, with side effects of treatment but no added benefit.

Importantly, although Tarceva is approved by the FDA for all patients with previously treated advanced NSCLC, regardless of whether their tumor has high levels of EGFR, the target of Tarceva, or amplification of the EGFR gene in tumor cells. We still debate whether Tarceva works best, or perhaps only works at all, in patients with EGFR protein expression as detected by a test called immunohistochemistry (or IHC) or amplification (excess copies) of the EGFR gene by a test called fluorescence in situ hybridization (or FISH). Many trials that are investigating the future role for Tarceva are using more selected populations based on clinical characteristics such as never-smoking or BAC, or molecular characteristics such as EGFR overexpression by IHC, gene amplification by FISH, or presence of an EGFR mutation detected by gene sequencing. Perhaps the benefits of Tarceva can be found to be more pronounced and more consistent if we can identify and treat those patients most likely to do well with it, rather than use a "targeted therapy" unselectively.

Further information about eligibility details and participating centers can be found here.

Next Previous link

Previous PostNext Post

Related Content

Article
Las biopsias líquidas están revolucionando la forma en que combatimos el cáncer, ofreciendo un futuro donde la detección y el tratamiento son más rápidos, precisos y menos invasivos.
Image
Videoteca de Cáncer de Pulmon - 2025
Video
Como parte de la Videoteca de Cáncer de Pulmón en Español 2025, oncólogos expertos discuten las opciones de tratamiento y la información más emergente en cáncer de pulmón. El Dr. Raez aborda la terapia para cánceres de pulmón EGFR y ALK, además de analizar otros tres temas de actualidad. La Dra. Viola y la Dra. Riaño también contribuyen a esta videoteca, cada una presentando tres temas relevantes sobre el cáncer de pulmón.
Article
The journey to conquer lung cancer is paved with scientific discovery, and the identification of the EGFR and ALK genes as crucial players marks a significant milestone. Unraveling how mutations in these seemingly small segments of our DNA can unleash the destructive force of cancer has opened up exciting new therapeutic avenues. This exploration delves into the cutting-edge world of EGFR and ALK-targeted therapies, highlighting the progress made and the ongoing quest for even more effective and personalized strategies to combat this formidable disease.

Recent Comments

JOIN THE CONVERSATION
COPD Herbal Remedy That Worked for Me
By phili2 on
COPD Herbal Remedy That Worked for Me
By phili2 on
COPD Herbal Remedy That Worked for Me
By phili2 on
Remarkable Results from COPD Herbal Treatment
By phili2 on