Combining Radiation Therapy and TKIs for Lung Cancer Treatment

Lung cancer is a common and serious disease. It is the second most common cancer type and the leading cause of cancer-related deaths. One specific type of lung cancer involves changes in the epidermal growth factor receptor (EGFR). In some areas, such as China and the Asia-Pacific region, about 51% of lung adenocarcinoma cases show these changes. This form of lung cancer usually has a less favorable outlook than cancers without these mutations.

For treatment, a group of drugs known as tyrosine kinase inhibitors (TKIS) has shown promise. These drugs work by blocking the activity of the EGFR, which helps to slow down cancer growth. Clinical studies have shown that these TKIs can be effective and safe for patients with advanced lung cancer that has these mutations. Thus, healthcare guidelines recommend TKIs as the first choice for treating this type of cancer.

However, treating inoperable stage III Non-small Cell Lung Cancer (NSCLC) with these mutations can be complex. Standard treatment is often a combination of Chemotherapy and radiation therapy. Unfortunately, studies have shown that the survival rate for patients undergoing this approach is low, with many experiencing a return of cancer after treatment.

Recent research suggests that combining radiation therapy (RT) with TKIs could be beneficial. Tests in laboratories have shown that TKIs might make cancer cells more sensitive to radiation, thus improving treatment outcomes. Previous clinical studies have generally combined RT with either TKIs or other types of drugs, but these studies often did not take genetic testing into account. New technology in genetic testing may offer better treatment options based on individual patient needs.

This article focuses on a study conducted to analyze the results of combining radiation therapy with TKIs in patients who have stage III lung cancer with EGFR mutations. The goal is to better understand the effectiveness and safety of this approach.

#Study Design and Patients

This study included patients with stage III EGFR-mutant non-small cell lung cancer who received treatment from December 2014 to December 2022. Data was collected from three hospitals. Information included patient details such as age, sex, smoking history, and genetic test results, among other relevant medical data.

To be included in the study, patients had to meet several criteria:

1. They must have a confirmed diagnosis of lung cancer.
2. Their cancer must show specific EGFR mutations, verified by genetic testing.
3. They must be classified as stage III non-small cell lung cancer based on established guidelines.
4. They must have received either RT combined with TKIs or RT combined with chemotherapy.

Patients who underwent surgery or only received one type of targeted therapy were excluded, as were those with incomplete medical information.

The final group of patients included 54 individuals. They were divided into two groups: one receiving RT and TKIs, and the other receiving RT and chemotherapy.

#Treatment Options

#RT and TKIs Group

Patients in this group received radiation therapy using advanced techniques to precisely target the tumor. The radiation dose varied between 54 to 66 Gy, depending on the individual case. Patients were treated with TKIs, including gefitinib, erlotinib, and others. These drugs were given continuously during radiation treatment.

#RT and Chemotherapy Group

In this group, patients received the same radiation therapy as the first group. However, instead of TKIs, they received standard chemotherapy based on combination regimens with platinum-based drugs. Each regimen had a set schedule, typically lasting several weeks.

#Follow-Up Procedures

Patients were watched closely after their treatment. The first follow-up visit occurred one month after completing radiation therapy, with further follow-ups every three months for two years and then every six months for the next three years. These follow-ups helped track treatment response and any changes in health.

#Evaluating Effectiveness

#Recent Treatment Outcomes

Recent treatment success was measured using specific criteria. Doctors classified the patients' responses as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). The overall response rate (ORR) assessed how many patients had either a CR or PR.

Both groups showed varying response rates, with the RT and TKIs group achieving an ORR of 86.1%, while the RT and chemotherapy had an ORR of 66.7%.

#Long-Term Effects

The study looked at how long patients lived without their cancer worsening, known as progression-free survival (PFS). For the RT and TKIs group, the median PFS was 26 months, while for the RT and chemotherapy group, it was 11 months. This indicates that the combination of radiation and TKIs led to a longer period without cancer progression.

Another outcome measured was overall survival (OS), which is how long patients lived overall. The OS rates were similar between the two groups, showing no significant difference.

#Treatment Failure Patterns

Among patients who experienced treatment failure, signs of cancer returned in most cases. Commonly, new cancers appeared in the brain or in the lungs. Patients in both groups received additional treatments after their initial therapy to address this progression.

#Adverse Effects

In terms of side effects, the RT and TKIs group generally experienced milder reactions than those receiving chemotherapy. Key issues related to chemotherapy included significant gastrointestinal and blood-related side effects. However, both groups experienced similar rates of radiation-related complications such as lung inflammation.

#Conclusions

The findings from this study suggest that combining radiation therapy with TKIs may offer better effectiveness than traditional chemotherapy for patients with stage III EGFR-mutant lung cancer. While both approaches have their merits, the use of TKIs appears to be a promising option, leading to a longer duration without cancer worsening.

This study adds to the growing evidence that targeted therapies like TKIs can improve outcomes for patients with specific genetic changes in their cancer. However, it is also important to consider that more research is needed, especially in larger studies, to confirm these results and further tailor treatments to individual patients.

In summary, using radiation therapy in combination with TKIs presents a safer and more effective alternative for treating certain lung cancers, positioning it as a valuable option in clinical practice.