Barbara Alicja Jereczek-Fossa, MD PhDEuropean Institute of OncologyUniversity of Milan, Milan, Italy

RADIOTHERAPY: TAKE HOME MESSAGE

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RADIOTHERAPY IS RAPIDLY CHANGING

VOLUME EVOLUTION

Large field RT

Ablative RT

ABLATIVE THERAPY

PRECISE RADIOTHERAPY

LESSON WE LEARNED

VALUE OF LOCAL THERAPY

1. Organ confined tumors

2. Locally advanced tumors

3. Metastatic tumors

E. Deutsch

M. Roach

Cella

By Diego Delso, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=21798666

UNEXPECTED FINDINGS

PFS: 3.9 months vs 11.9 months

Local consolidative therapy versus maintenance therapy or observation for patientswith oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study.Gomez DR, Blumenschein GR Jr, Lee JJ, Hernandez M, Ye R, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Gibbons DL, Karam JA, Kavanagh BD, Tang C, Komaki R, Louie AV, Palma DA, Tsao AS, Sepesi B, William WN, Zhang J, Shi Q, Wang XS, Swisher SG, Heymach JV.Lancet Oncol. 2016 Dec;17(12):1672-1682.

Local consolidative therapy versus maintenance therapy or observation for patientswith oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study.Gomez DR, Blumenschein GR Jr, Lee JJ, Hernandez M, Ye R, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Gibbons DL, Karam JA, Kavanagh BD, Tang C, Komaki R, Louie AV, Palma DA, Tsao AS, Sepesi B, William WN, Zhang J, Shi Q, Wang XS, Swisher SG, Heymach JV.Lancet Oncol. 2016 Dec;17(12):1672-1682.

Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial.Lyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H, Timmerman RD.JAMA Oncol. 2018 Jan 11;4(1):e173501.

P. Ost

Local aggressive therapy

“Local consolidative therapy is changing the natural history of cancer by

limiting the potential for later spread

altering systemic anticancer immune responses to facilitate longer control of subclinical disease”

RT enhanced the presentation and diversity of tumour-associated antigens

Preclinical data: RT + checkpoint inhibition immunotherapy produces synergistic antitumour responses

Prospective clinical studies: checkpoint blockade is becoming a standard treatment in advanced NSCLC

Proportion of unselected patients who respond to checkpoint inhibition is 20% ->

need for strategies to boost response

NSCLC: RT + immunotherapy

RT improves the activity of pembrolizumab in advanced NSCLC with a clinically acceptable safety profile

Extracranial RT

Extracranial RT

Any RT

Any RT

Previous radiotherapy and the clinical activity and toxicity of pembrolizumabin the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial.Shaverdian N, Lisberg AE, Bornazyan K, Veruttipong D, Goldman JW, FormentiSC, Garon EB, Lee P.Lancet Oncol. 2017 Jul;18(7):895-903.

E. Deutsch

SRS should be a standard approach after brain metastasectomy

PATIENTS COME FIRST

ACHIEVEMENTS

1. Tumor outcome & toxicity

2. Convenience & compliance

3. QoL

R. Orecchia

R. Orecchia

R. Orecchia

Van As

Two papers – Green journal and red journal

Green JournalStereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials.King CR, Freeman D, Kaplan I, Fuller D, Bolzicco G, Collins S, Meier R, Wang J, Kupelian P, Steinberg M, Katz A.Radiother Oncol. 2013 Nov;109(2):217-21. doi: 10.1016/j.radonc.2013.08.030. Epub 2013 Sep 20.

Red Journal

Health-related quality of life after stereotactic body radiation therapy for localized prostate cancer: results from a multi-institutional consortium of prospective trials.King CR, Collins S, Fuller D, Wang PC, Kupelian P, Steinberg M, Katz A.Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):939-45. doi: 10.1016/j.ijrobp.2013.08.019. Epub 2013 Oct 9.

El Shafie

Klass

TAKE HOME MESSAGES

Importance of local therapy

Systemic effect of local therapy

Best combination?

Incorporate molecular tests

GOODBYE LISBON!