Zie ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij longkanker waaronder opvallend veel TCM - Chinese kruiden staan vermeld van arts-bioloog drs. Engelbert Valstar

5 april 2023: Bron: International journal of radiation oncology, Published:April 04, 2023

Wanneer in een vroeg stadium van niet-kleincellige longkanker bij ouderen (gemiddelde leeftijd 79 jaar) SABR (Stereotactisch precisie bestraling met hoge dosis met als doel chirurgische verwijdering van de kwaadaardige tumor) wordt gecombineerd met durvalumab, een vorm van immuuntherapie met anti-PD medicijn, dan hebben de meeste patiënten daar baat bij met een behoorlijke verlenging van overall overleving zonder al te veel ernstige bijwerkingen, al blijken wel 5 patiënten ernstige bijwerkingen te hebben gehad.

Al in 2011 schreven we in dit artikel: "SARB - stereo tactische bestraling en chirurgische verwijdering van longtumoren bij longkankerpatienten met longkanker stadium I hebben de overlevingskansen van longkankerpatienten en vooral van de ouderen met longkanker stadium I sterk verbeterd."

Nu blijkt uit de eerste resultaten van een fase I/II studie bij 18 oudere patiënten dat SARB in combinatie met durvalumab ook goede resultaten geeft op overleving en voorkomen van recidief.

Een andere studie met SABR is deze (abstract verderop in artikel):
Het abstract is heel summier dus heb een vertaling gemaakt van de resultaten uit het abstract:

RESULTATEN:

18 patiënten kregen een combinatie van SABR en durvalumab. Met een mediane leeftijd van 79 jaar was 61,1% man, 72,2% cT1 en 27,8% cT2.
88,9% van de patiënten werd behandeld tot 54 Gy in 3 fx en 77,8% kreeg alle 5 cycli van durvalumab.
De 1- en 2-jaars LC-percentages waren respectievelijk 100% en 93,8%,
1- en 2-jaars PFS-percentages 94,4% en 83,3%, en 1- en 2-jaars OS-percentages 94,4% en 88,9%.
De 2-jaars cumulatieve incidentie voor LCSM (longkanker specifieke sterfte) was 5,6%.
Patiënten met acute en late graad ≥3 behandelingsgerelateerde toxiciteiten omvatten pulmonale (27,8%, 5/18), cardiale (5,6%, 1/18) en GI (0%).
Er werd één voorval van graad 5 waargenomen in de setting van niet eerder gediagnosticeerde interstitiële longziekte (ILD).

CONCLUSIES:

Voor niet-kleincellige longkanker (NSCLC) in een vroeg stadium resulteerde de combinatie van SABR en durvalumab in uitstekende ziektespecifieke resultaten. De veiligheid leek per protocol acceptabel, maar 5/18 patiënten ondervonden graad ≥3 pulmonale toxiciteit waaronder één graad 5 voorval bij een patiënt met ILD. De resultaten ondersteunen lopende fase III-onderzoeken die het voordeel van SABR en immuuncontrolepuntremmers in deze populatie bepalen.

Het originele abstract is dit. Voor het volledige studierapport moet betaald worden.

RAPID COMMUNICATION|ARTICLES IN PRESS

Safety and Efficacy Results from iSABR, a Phase I Study of Stereotactic Ablative Radiotherapy (SABR) in Combination with Durvalumab for Early-Stage Medically Inoperable Non-Small Cell Lung Cancer (NSCLC)

Published:April 04, 2023DOI:https://doi.org/10.1016/j.ijrobp.2023.03.069

ABSTRACT

PURPOSE/OBJECTIVE

: To determine the safety and tolerability of combining stereotactic ablative radiotherapy (SABR) and durvalumab with respect to rates of Grade ≥3 non-hematological toxicity in medically inoperable patients with early-stage non-small cell lung cancer (NSCLC).

METHODS

: This was a prospective multicenter trial designed as a phase II study with phase I safety lead-in enrolling from 2017- 2020. Patients with biopsy-proven clinical stage I or IIA NSCLC (per AJCC 7th edition) and were medically inoperable or refused surgery, received 1 cycle of durvalumab followed by SABR or hypofractionated radiation (54 Gy in 3 fractions , 50 Gy in 4 fx, or 65 Gy in 10 fx), then up to 4 additional cycles of durvalumab (1500 mg q4 weeks). Incidence of treatment-related Grade ≥3 toxicities were tabulated. Local control (LC), progression-free survival (PFS), overall survival (OS), and lung cancer specific mortality (LCSM) were assessed using the Kaplan-Meier method.

RESULTS

: 18 patients received combination SABR and durvalumab. With a median age of 79 years, 61.1% were male, 72.2% cT1, and 27.8% cT2. 88.9% of patients were treated to 54 Gy in 3 fx and 77.8% received all 5 cycles of durvalumab. The 1- and 2-year LC rates were 100% and 93.8%, 1- and 2-year PFS rates 94.4% and 83.3%, and 1- and 2-year OS rates 94.4% and 88.9%, respectively. The 2-year cumulative incidence for LCSM was 5.6%. Patients with acute and late Grade ≥3 treatment-related toxicities included pulmonary (27.8%, 5/18), cardiac (5.6%, 1/18), and GI (0%). One Grade 5 event in the setting of previously undiagnosed interstitial lung disease (ILD) was observed.

CONCLUSIONS

: For early-stage NSCLC, combination SABR and durvalumab resulted in excellent disease specific outcomes. Safety appeared acceptable per protocol, but 5/18 patients experienced Grade ≥3 pulmonary toxicity including one Grade 5 event in a patient with ILD. Results support ongoing phase III trials determining the benefit of SABR and immune check point inhibitors in this population.

Article info

Publication history

Accepted: March 28, 2023

Received in revised form: March 22, 2023

Received: December 28, 2022

Publication stage

In Press Journal Pre-Proof

Identification

DOI: https://doi.org/10.1016/j.ijrobp.2023.03.069

Copyright

ScienceDirect

Access this article on ScienceDirect

The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care.

Original Research Article

https://doi.org/10.1016/j.ctro.2022.03.001 Get rights and content

Under a Creative Commons license

open access

Highlights

•
Stereotactic Ablative Body Radiotherapy (SABR) plays a major role in the management of early-stage non-small cell lung cancer (NSCLC).
•
An evidence-based model is developed to estimate optimal rates of lung SABR utilisation within the Australian population.
•
Optimal utilisation rates are compared against actual utilisation rates to evaluate service provision.

Abstract

Background and purpose

Radiotherapy utilisation rates considerably vary across different countries and service providers, highlighting the need to establish reliable benchmarks against which utilisation rates can be assessed. Here, optimal utilisation rates of Stereotactic Ablative Body Radiotherapy (SABR) for lung cancer are estimated and compared against actual utilisation rates to identify potential shortfalls in service provision.

Materials and Methods

An evidence-based optimal utilisation model was constructed after reviewing practice guidelines and identifying indications for lung SABR based on the best available evidence. The proportions of patients likely to develop each indication were obtained, whenever possible, from Australian population-based studies. Sensitivity analysis was performed to account for variations in epidemiological data. Practice pattern studies were reviewed to obtain actual utilisation rates.

Results

A total of 6% of all lung cancer patients were estimated to optimally require SABR at least once during the course of their illness (95% CI: 4–6%). Optimal utilisation rates were estimated to be 32% for stage I and 10% for stage II NSCLC. Actual utilisation rates for stage I NSCLC varied between 6 and 20%. For patients with inoperable stage I, 27–74% received SABR compared to the estimated optimal rate of 82%.

Conclusion

The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care. The model can be easily modified to determine optimal utilisation rates in other populations or updated to reflect any changes in practice guidelines or epidemiological data.