Preventive Radiation Reduces Lung Cancer Brain Metastases
According to results recently presented at the ASCO annual meeting, prophylactic cranial radiation following treatment with chemotherapy doubles survival at 1 year and reduces the risk of developing brain metastases among patients with extensive-disease small-cell lung cancer (SCLC).
About 70 percent of SCLC patients have disease that has already spread extensively at the time of their diagnosis, and a significant number of patients develop brain metastases. Previous studies have shown that prophylactic cranial irradiation (PCI) prevents brain metastases and improves survival in SCLC patients who have local disease and a complete response to initial chemotherapy. New results presented at the ASCO meeting indicate that this strategy remains sound, even when SCLC has spread extensively.
Findings were presented by lead author Dr. Ben Slotman of the VU University Medical Center in Amsterdam. The trial randomized 286 patients who had responded to 4 to 6 cycles of chemotherapy to observation or PCI consisting of 20 to 30 Gy administered in 5 to 12 fractions. At 1 year, symptomatic brain metastases occurred in 14.6 percent of patients treated with cranial radiation compared with 40.4 percent of patients in the observation group. Survival was doubled at 1 year for patients treated with cranial radiation compared with those in the observation group (27.1 versus 13.3 percent, respectively). Radiation was well tolerated and the most common side effects were headache, nausea and vomiting, and fatigue.
Children Survive Neuroblastoma with Less Intensive Treatment
On Sunday, June 3, researchers from the Children's Oncology Group presented results at the ASCO annual meeting from a multinational study showing that a treatment regimen more patient-friendly than the current standard can achieve comparable survival rates among infants and children with intermediate risk neuroblastoma.
Researchers substituted carboplatin for cisplatin, a drug that can cause long-term side effects such as hearing loss, in the multi-agent drug treatments that they administered to study patients. They also reduced the length and number of cycles so that patients received 10 to 18 days of treatment over an 84- to 168-day period, as opposed to the standard 71 days of treatment over 286 days. The researchers compared the survival rate achieved by the new treatment with that observed for prior clinical trials of standard treatments.
After an average follow-up of 3 years, survival among the 467 infants and children was 96 percent, which is comparable to or better than that seen in large trials of standard treatment. Furthermore, less than 2 percent of the patients had major damage to their heart, kidney, liver, or hearing - a better than usual outcome.
"The paradigm we are continually striving for is to cure as many children as possible while reducing the burden of treatment," said the study's lead author, Dr. David Baker of Princess Margaret Hospital for Children in Perth, Australia, in an ASCO press briefing. "This goes a long way toward meeting that goal."
Kidney Cancer Patients Benefit from Avastin
Bevacizumab (Avastin) is the fourth targeted drug in recent years to help patients with advanced kidney cancer, a disease that historically has been difficult to treat. A final-stage, randomized trial presented at the ASCO annual meeting found that the combination of bevacizumab and interferon was more effective than interferon and placebo. Adding bevacizumab nearly doubled the time the disease took to progress - from 5.4 months to 10.2 months - without creating significant new toxicities.
Interferon was the standard treatment for advanced kidney cancer when the trial began. But last year three targeted drugs - sunitinib (Sutent), sorafenib (Nexavar), and temsirolimus (Torisel) - emerged as the first new kidney cancer medicines in two decades, changing the standard of care. The new results demonstrate for the first time that bevacizumab, which is approved for advanced colorectal and non-small-cell lung cancers, is also effective against kidney cancer.
"The benefits of bevacizumab and interferon were greater than we expected," said lead investigator Dr. Bernard Escudier of the Gustave Roussy Institute in France. "We now need studies to compare the different therapies." Bevacizumab will likely be tested as a single agent against the other therapies in the coming years, he said.
The response rate in the trial of 649 patients was 31 percent for the bevacizumab group compared with 13 percent for the placebo group. After an interim analysis showed a clear benefit, all patients were offered the bevacizumab combination. Preliminary data suggest that bevacizumab may prolong survival, but additional studies are needed.
Combinations of targeted therapies may be needed to achieve the maximum benefit for patients. Toward this end, an early-stage clinical trial presented at ASCO showed that some patients tolerated a combination of sunitinib and bevacizumab. As dosage information becomes available, the combination may be appropriate for phase II trials in metastatic renal cell carcinoma as well as other cancers, the researchers said.
Cetuximab Extends Survival in Recurrent Head and Neck Cancer
Cetuximab (Erbitux), a monoclonal antibody targeting the epidermal growth factor receptor, has proven effective in treating several kinds of head and neck cancer. It was approved last year by the FDA for initial treatment of advanced squamous cell carcinoma of the head and neck (SCCHN). Researchers at last week's ASCO meeting reported the results of the European EXTREME trial, and added to accumulating evidence that cetuximab also has a role in treating the disease when it recurs or metastasizes.
Lead author Dr. Jan B. Vermorken from the University of Antwerp in Belgium called the survival benefit - a 21-percent risk reduction with cetuximab patients surviving 10.1 months, 2.7 months longer than those receiving standard care - "among the longest ever seen in a large clinical trial among these patients." For more than two decades, progress in this setting had plateaued. Patients with recurrent or metastatic SCCHN usually receive platinum-based, palliative chemotherapy, sometimes with an intent to cure, but most do not survive beyond 6 to 7 months.
All 442 patients received standard care: up to six cycles of chemotherapy with 5-fluorouracil plus either carboplatin or cisplatin. The experimental group also received cetuximab, until the disease progressed or unacceptable toxicity levels were reached. The most common side effect associated with cetuximab was a controllable rash.
Shark Cartilage Ineffective Against Lung Cancer
A clinical trial to rigorously evaluate shark cartilage as a cancer therapy found no benefits for patients. Lung cancer patients who took AE-941 (Neovastat) along with chemotherapy and radiation lived no longer than patients who did not (about 15 months), researchers reported at the ASCO annual meeting. The final-stage clinical trial was cosponsored by NCI and included 384 patients.
Physicians know that many cancer patients consume natural products that have not been scientifically tested and that may interact with conventional treatments. The cartilage study was designed to see whether a natural product developed as a pharmaceutical and put through standard clinical testing might benefit cancer patients. Unlike the products sold in stores and over the Internet, AE-941 was available only through the trial.Early testing suggested that the drug may block the growth of blood vessels that feed tumors, but in the end the results were negative. "AE-941 is not an effective therapeutic agent for lung cancer," said lead investigator Dr. Charles Lu of the University of Texas M.D. Anderson Cancer Center.