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  • Jun 9, 2020
    SABR for oligometastases shows benefits in long-term follow-up

    The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long term disease control if all sites of disease can be ablated. Although there have been several retrospective studies, there is limited randomized data. This article reports the long-term update of the SABR COMET trial which randomized patients with oligometastatic disease, defined as a controlled primary malignancy with 1-5 metastatic lesions, to palliative standard of care vs standard of care plus the addition of SABR. Between 2012 and 2016, 99 patients were randomly assigned at 10 centers internationally. The most common primary tumor types were breast (n 5 18), lung (n 5 18), colorectal (n 5 18), and prostate (n 5 16). Median follow-up was 51 months. The 5-year OS rate was 17.7% in arm 1 (95% CI, 6% to 34%) versus 42.3% in arm 2 (95% CI, 28% to 56%; stratified log-rank P5.006). The 5-year PFS rate was not reached in arm 1 (3.2%; 95% CI, 0% to 14% at 4 years with last patient censored) and 17.3% in arm 2 (95% CI, 8% to 30%; P 5 .001). There were no new grade 2-5 adverse events and no differences in QOL between arms. At a median follow up of 51 months, there was a large statistically significant difference in overall survival, 5-yr OS (17.7% vs 42.3%) with the addition of SABR. There were no new safety concerns and there was no significant detriment on QOL. These promising results, pending confirmation in phase III randomized studies, support the expanded use of SABR/SBRT for patients with oligometastatic disease.

    (Open Access)

    Reference (PubMed Link): Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: Long-term results of the sabr-comet phase ii randomized trial. J Clin Oncol 2020:Jco2000818.

    Key Institution: Multi-Institutional
    Keywords: Oligometastases, SBRT, COMET trial

  • Mar 9, 2020
    Protons reduce toxicity for esophageal cancer

    Several dosimetric studies and retrospective studies have suggested that proton beam therapy could reduce normal tissue toxicity compared with IMRT. However, proton beam therapy is substantially more expensive, and there is insufficient evidence that proton beam therapy leads to clinically meaningful differences in patient outcomes. In this single-institution randomized trial, the authors compared proton beam therapy and IMRT for locally advanced esophageal cancer. The authors found that proton beam therapy significantly reduced the total toxicity burden (TTB) and rate of post-operative complications compared with IMRT with similar rates of PFS and OS at 3 years. Remarkably, the postoperative complication score was 7.6 times higher for patients treated with IMRT. Interestingly, there were no significant differences in quality of life between the arms. This study provides the first randomized evidence that proton beam therapy can improve patient outcomes over IMRT. However, the primary endpoint of TTB has not been previously validated, and it is unclear that an improvement in TTB can economically justify routine use of proton beam therapy for esophageal cancer. The currently ongoing NRG-GI006 trial will help to evaluate the findings of this trial in a larger multi-institutional setting.

    Reference (PubMed Link): Lin SH, Hobbs BP, Verma V, et al. Randomized phase iib trial of proton beam therapy versus intensity-modulated radiation therapy for locally advanced esophageal cancer. J Clin Oncol 2020;38:1569-1579.

    Key Institution: Multi-Institutional
    Keywords: Locally advanced esophageal cancer, proton beam therapy, total toxicity burden, NCT01512589 

  • Mar 9, 2020
    Pre-op chemoRT resectable/borderline resectable pancreatic cancer

    Patients (N=246) with resectable/borderline resectable pancreatic cancer were randomly assigned to receive preop chemoRT or immediate surgery in this phase 3 trial. Overall survival trended towards improvement with preop chemoRT (16.0 months, HR 0.78 (95% confidence interval [CI], 0.58 to 1.05), N=119) vs 14.3 months, (N=127), with P=0.096). R0 resection occurred in 71% vs 40% of patients with vs without preop chemoRT. Disease-free and locoregional failure-free survival were improved with vs without preop chemoRT. Overall survival was improved in a subset of patients who underwent resection and adjuvant chemotherapy with vs without preop chemoRT.

    Reference (PubMed Link): Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Results of the dutch randomized phase iii preopanc trial. J Clin Oncol 2020;38:1763-1773.

    Key Institution: Multi-Institutional (Netherlands)
    Keywords: Pancreas, Surgery, Chemoradiation 

  • Mar 9, 2020
    Pembrolizumab and concurrent chemoradiotherapy for advanced lung cancer

    Twenty-one participants had locally advanced, unresectable, stage III NSCLC, Eastern Cooperative Oncology Group performance status 0 or 1, and adequate hematologic, renal, and hepatic function.

    Pembrolizumab was combined with concurrent chemoradiotherapy (weekly carboplatin and paclitaxel with 60 Gy of radiation in 2 Gy per d). Progression-free survival was good, with relatively few serious immune-related adverse events.

    Consolidative immunotherapy following chemoradiation for locally advanced NSCLC was shown to improve survival in the PACIFIC trial. The use of concurrent immunotherapy with radiation in intriguing but there is little data regarding safety and efficacy. This Phase 1 study demonstrates that concurrent chemoimmunoradiotherapy is tolerable in this population, with further studies required to evaluate efficacy.

    (Open Access)

    Reference (PubMed Link): Jabbour SK, Berman AT, Decker RH, et al. Phase 1 trial of pembrolizumab administered concurrently with chemoradiotherapy for locally advanced non-small cell lung cancer: A nonrandomized controlled trial. JAMA Oncol 2020;6:1-8.

    Key Institution: Multi-Institutional (Royal Marsden Hospital, Institute of Cancer Research, London, UK)
    Keywords: Immunotherapy, Chemoradiotherapy, Locally Advanced Non-small Cell Lung Cancer 

  • Dec 20, 2019
    Protons reduce toxicity for locally advanced cancer compared to photons

    This is a large, multi-institutional, retrospective, nonrandomized comparative effectiveness study that included 1483 adult patients with nonmetastatic, locally advanced cancer that was treated with concurrent chemotherapy and radiotherapy with curative intent. The primary endpoint was 90-day CTCAE adverse events of grade3 or above. The results showed that proton chemoradiotherapy was associated with a significantly lower relative risk of 90-day adverse event of at least grade 3 (relative risk = 0.31, with 95% confidence interval 0.65- 0.93, p=0.006), as well as decline in performance status during treatment (relative risk = 0.561, 95% confidence interval0.37 - 0.71, p<0.001). There was no difference in disease-free or overall survival.

    Reference (PubMed Link): Baumann BC, Mitra N, Harton JG, et al. Comparative effectiveness of proton vs photon therapy as part of concurrent chemoradiotherapy for locally advanced cancer. JAMA Oncol 2019.

    Key Institution: Multi-Institutional (US)
    Keywords: Proton therapy, toxicity