Should SBRT be added to TKI treatment for advanced EGFR-positive non-small cell lung cancer?

This trial was carried out to assess the effectiveness of EGFR-tyrosine kinase inhibitors (TKIs) with stereotactic body radiation therapy (SBRT) in advanced non-small-cell lung cancer (NSCLC). The authors found that TKIs plus SBRT improved the survival without disease worsening for these patients. 

Lung cancer is one of the most common types of cancer worldwide. It is commonly difficult to treat due to the late stage at diagnosis. Some NSCLCs have a genetic abnormality called EGFR. This causes excess growth of cancer cells. EGFR-targeted therapies such as erlotinib (Tarceva) or gefitinib (Iressa) are available for these patients.

However, many patients eventually become resistant to EGFR therapy and need other types of therapy. Radiation therapy such as SBRT is an option. SBRT involves delivering very precise high-dose radiation to cancer cells while minimizing damage to surrounding tissues. It was suggested that SBRT may prolong the survival of patients with NSCLC undergoing EGFR therapy and delay resistance to these drugs. However, real-world data assessing the use of TKIs in combination with SBRT in patients with advanced NSCLC is missing. 

The study had 308 patients with advanced NSCLC. 262 patients received EGFR therapy alone and 46 patients received EGFR therapy with SBRT. SBRT was given after at least 8 weeks of EGFR therapy.

The average survival without cancer worsening was 19.4 months in the SBRT and EGFR therapy group compared to 13.7 months in the EGFR therapy alone group. 

There were no severe side effects reported in either group. The most common side effects were skin rashes and were mild and similar for both groups. 

The authors found that the use of EGFR targeted therapy in combination with SBRT increased survival without cancer worsening and was well tolerated in patients with EGFR-positive, advanced NSCLC. 

This study was based on medical records. The number of patients in the SBRT group was very small. Further randomized studies are needed.