Can radiation and EGFR inhibitors improve outcomes in advanced non-small cell lung cancer?

This study looked at the usefulness of radiotherapy in combination with EGFR inhibitors in patients with advanced non-small cell lung cancer (NSCLC).

66% of patients with non-small cell lung cancer (NSCLC) develop stage IV cancer, where the cancer spreads to both lungs and around the body. Today, stage IV NSCLC is still difficult to control.

Some lung cancers depend on the epidermal growth factor receptor (EGFR) for growth. Erlotinib (Tarceva) is a type of drug that blocks EGFR.  It is usually given to patients after they have tried chemotherapy.

Stereotactic body radiation therapy (SBRT) treats the cancer by using beams of radiation to kill the cancer cells. It is not clear whether SBRT would be more effective when used in combination with EGFR inhibitors.

24 patients with stage IV NSCLC were included in this study. All patients had progressed following chemotherapy to treat their lung cancer. Patients received SBRT at every tumor site. Patients also received erlotinib until disease progression.

Average progression free survival (time from treatment until the disease progresses) was 14.7 months. Average overall survival (time from treatment until death from any cause) was 20.4 months. Patients with more tumors needing treatment with SBRT had 1.5 times the risk of death for each extra site treated.

14% of tumors recurred at the original site treated by SBRT. 47.6% of tumors recurred at new sites. Some patients had side effects from the treatment, including lung infections and back pain. Most of these effects were mild, but one patient developed serious pneumonia. 

The authors concluded that a combination  of erlotinib and SBRT was associated with more positive outcomes for patients with stage IV NSCLC.

The authors acknowledged that the number of patients in the trial was very small and that they were not randomly selected.

The study was also funded by  OSI Pharmaceuticals, the manufacturers of erlotinib.