The combination of the chemotherapy regimen, erlotinib, with stereotactic body radiation therapy, known as SBRT, improved overall survival time to 20 months compared to historic 6- to 9- month survival times among erlotinib-only treated patients. The combination improved progression free survival – the time without the reappearance of cancer − from the historical two to four months to 14.7 months for similarly selected lung cancer patients.
“Our approach dramatically changed the pattern of relapse. We saw a shift in failure from existing, local sites to new, distant sites,” said senior author Dr. Robert Timmerman, Director of the Annette Simmons Stereotactic Treatment Center, and Vice Chairman of Radiation Oncology at UT Southwestern. “This shift resulted in a surprisingly long remission from the reappearance of cancer in treated patients.”
According to the National Cancer Institute, lung cancer will be diagnosed in an estimated 224,210 men and women during 2014. Five year relative survival rates remain low at just 16.8 percent from 2004-10. Of these cancer cases, about 85 percent fall into the category of non-small cell lung cancer.
Dr. Timmerman, holder of the Effie Marie Cain Distinguished Chair in Cancer Therapy Research, is a member of UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, the only National Cancer Institute-designated cancer center in North Texas and a National Clinical Trials Network Lead Academic Site.
This Phase 2 clinical trial involved 24 patients with stage 4 non-small cell lung cancer (NSCLC) whose cancer has continued to spread during their initial therapy. Such patients typically have poor survival rates, and SBRT is not typically used in these patients, said first author Dr. Puneeth Iyengar, Assistant Professor and Director of Clinical Research of Radiation Oncology, and co-leader of the Simmons Cancer Center Thoracic Oncology Group.
The revolutionary SBRT technique is a type of radiation therapy in which a few very high doses of radiation are delivered from multiple angles to small, well-defined tumors. The goal is to deliver a radiation dose high enough to kill the cancer, while minimizing exposure to surrounding healthy tissue and organs, explained Dr. Timmerman, who directs Clinical Research and the Image-Guided Stereotactic Radiation Therapy in the Department of Radiation Oncology.
SBRT has been shown to offer better cure rates in certain instances, particularly for cancers that have metastasized, said Dr. Timmerman, Professor of Radiation Oncology and Neurological Surgery, who was one of the first researchers in the world to use the SBRT techniques initially developed for brain tumors to treat cancer in the body.
“Technologies have developed in the last few years that have yielded game-changing, paradigm-shifting approaches, allowing us to reconsider how radiation is delivered in combination with surgery, chemotherapy, and other systemic therapies,” said Dr. Timmerman, who served as the lead investigator in several national trials designed to evaluate the efficacy and safety of SBRT to treat cancer in the lung, liver, spine, and prostate. “I am motivated by the need I see every day in the clinic to provide better treatments for our patients.”
The results are reported in the Journal of Clinical Oncology of the American Society of Clinical Oncology.
Other UT Southwestern researchers included Dr. Hak Choy, Chairman of Radiation Oncology, who holds The Nancy B. & Jake L. Hamon Distinguished Chair in Therapeutic Oncology Research; Dr. Chul Ahn, Professor of Clinical Sciences; Dr. David Gerber, Associate Professor of Internal Medicine; Dr. Jonathan Dowell, Associate Professor of Internal Medicine; Dr. Randall Hughes, Associate Professor of Internal Medicine; Dr. Ramzi Abdulrahman, Associate Professor of Radiation Oncology; Postdoctoral researcher Dr. Zabi Wardak; and researchers from the University of Colorado School of Medicine.
The trial was supported by OSI Pharmaceuticals. Dr. Timmerman reported receiving research funding from Varian and OSI Pharmaceuticals; Dr. Gerber reported receiving research funding from Genentech and OSI Pharmaceuticals; Dr. Ahn reported a consulting/advisory role with Celltrion; Dr. Dowell reported receiving research funding from Verastem, MedImmune, Eli Lily, MolMed, Peregrine and a speaker’s bureau role with Genentech; Dr. Hughes reported stock or other ownership with Pfizer; Dr. Choy reported research funding from Celgene and a consulting/advisory role with Bayer and EMD Serono.
The Annette Simmons Stereotactic Treatment Center at Zale Lipshy University Hospital provides treatment with state of the art cancer-fighting tools, including Gamma Knife and CyberKnife.
UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center is one of just 68 NCI-designated cancer centers in the nation. The Simmons Cancer Center includes 13 major cancer care programs with a focus on treating the whole patient with innovative treatments, while fostering groundbreaking basic research that has the potential to improve patient care and prevention of cancer worldwide. In addition, the Center’s education and training programs support and develop the next generation of cancer researchers and clinicians.
In addition, the Simmons Cancer Center is among only 30 U.S. cancer research centers to be named a National Clinical Trials Network Lead Academic Site, a prestigious new designation by the NCI, and the only Cancer Center in North Texas to be so designated. The designation and associated funding is designed to bolster the cancer center’s clinical cancer research for adults and to provide patients access to cancer research trials sponsored by the NCI, where promising new drugs often are tested.
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering approximately 2,800, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.
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