Gefitinib Combined With Stereotactic Radiosurgery in Previously Treated Patients With Advanced Non–Small Cell Lung Cancer

Abstract

The SBRT combined with gefitinib is a promising treatment strategy for advanced (stage IIIb or IV) NSCLC after the failure of previously chemotherapy. This method improves local control and disease-related symptoms with tolerated toxicity, and even increases the progression-free survival and OS.

Pattern of Failure Analysis in Metastatic EGFR-Mutant Lung Cancer Treated with Tyrosine Kinase Inhibitors to Identify Candidates for Consolidation Stereotactic Body Radiation Therapy

“…Although only one patient was treated with SBRT to the lung, local therapy was associated with a median time to progression of 10 months and a median survival time of 41 months. Finally, Wang et al 23 treated 14 NSCLC patients (not limited to EGFR-mutant disease) with disease progression after platinum-based chemotherapy with gefitinib and SBRT directed at progressive metastatic disease. The 1-year local control and overall survival rates were 83.9% and 69.6%, respectively.…”

“…Together, these studies reveal a potential role for the addition of metastasis-directed SBRT in improving disease control and PFS in stage IV EGFR-mutant NSCLC patients treated with TKI. [21][22][23] This study has the typical limitations of a retrospective analysis including a relatively small number of patients and potential for selection bias. Our findings, which should be viewed as hypothesis generating, suggest that consolidation SBRT with continued TKI therapy has the potential to alter the natural history of disease progression and extend the PFS and overall survival of a subset of patients with stage IV EGFR-mutant NSCLC.…”

“…[15][16][17] To improve disease control in the treatment of progressive oligometastatic or oligoprogressive disease, there has been an increased interest in evaluating the benefits of local therapies, such as stereotactic body radiation therapy (SBRT). [18][19][20][21][22][23][24][25] SBRT is an advanced radiation therapy modality that involves the delivery of ablative individual doses of radiation to tumors in various extracranial sites. [26][27][28] A number of studies have shown that SBRT can achieve high rates of local control of treated lesions in patients with limited pulmonary, hepatic, adrenal, and spinal metastases.…”

Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: A systematic review

“…Regarding extra-cranial SRT, the prospective study of Wang et al used SRT to treat a maximum of 3 lung metastases in stage IV NSCLC patients (n = 14) with concurrent gefitinib [51]. Grade 3 toxicity possibly caused by the concurrent treatment occurred in 4 patients (29%), consisting of stomatitis, esophagitis, and radiation pneumonitis (n = 3) ( Table 2).…”

Misjudgement of gefitinib efficacy in patients with central non-small-cell lung cancer due to obstructive atelectasis caused by stereotactic radiotherapy

“…The main advantage of SBRT is its short radiation time and less damage to the surrounding tissues, resulting in a decreased risk of radiation pneumonitis in lung cancer. Wang et al (15) reported that in 14 patients with advanced NSCLC, SBRT combined with gefitinib resulted in a disease remission rate of up to 57.1%. The median time of disease remission was 8 months, while the 1-year survival rate was 69.6%, suggesting that this regimen may improve local control and disease remission rates with few side effects.…”