Abstract:Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) has become the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) patients with EGFR-sensitive mutations. However, acquired resistance cannot be avoided during the targeted treatment of EGFR-TKI, which may lead to the progression of NSCLC. Among them, approximately 50% of patients present with primary lung lesions and/or initial metastastic lesion progression. As a major local treatment, radiation therapy plays an irreplaceable role in the management of patients with advanced cancer. Stereotactic body radiation therapy (SBRT), which is implemented with the Cyberknife, is the most advanced radiation therapy technology to better meet clinical needs. In recent years, based on the abovementioned patterns of tumor recurrence, the treatment mode of pulmonary-lesion SBRT combined with EGFR-TKI can improve the tumor-free survival in advanced NSCLC patients, which has attracted widespread attention. In this article, the clinical research progresses on this combined therapeutic strategy were reviewed.
Zhu Kuikui,Li Zhenyu,Zhang Sheng et al. Clinical research progress on EGFR-TKI combined with pulmonary SBRT in advanced non-small cell lung cancer with EGFR-sensitive mutations[J]. Chinese Journal of Radiation Oncology, 2021, 30(5): 514-517.
[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492. [2] Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014[J]. Chin J Cancer Res, 2018, 30(1):1-12. DOI:10.21147/j.issn.1000-9604.2018.01.01. [3] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567. DOI:10.1016/S2214-109X (18)30127-X. [4] Travis WD, Brambilla E, Nicholson AG, et al. The 2015 world health organization classification of lung tumors:impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol, 2015, 10(9):1243-1260. DOI:10.1097/JTO.0000000000000630. [5] Zhou C, Yao LD. Strategies to improve outcomes of patients with EGRF-mutant non-small cell lung cancer:review of the literature[J]. J Thorac Oncol, 2016, 11(2):174-186. DOI:10.1016/j.jtho.2015.10.002. [6] Johnson DH, Schiller JH, Bunn PA Jr. Recent clinical advances in lung cancer management[J]. J Clin Oncol, 2014, 32(10):973-982. DOI:10.1200/JCO.2013.53.1228. [7] Diwanji TP, Mohindra P, Vyfhuis M, et al. Advances in radiotherapy techniques and delivery for non-small cell lung cancer:benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy[J]. Transl Lung Cancer Res, 2017, 6(2):131-147. DOI:10.21037/tlcr.2017.04.04. [8] Timmerman RD, Hu C, Michalski JM, et al. Long-term results of stereotactic body radiation therapy in medically inoperable stage Ⅰ non-small cell lung cancer[J]. JAMA Oncol, 2018, 4(9):1287-1288. DOI:10.1001/jamaoncol.2018.1258. [9] Timmerman RD, Paulus R, Pass HI, et al. Stereotactic body radiation therapy for operable early-stage lung cancer:findings from the NRG oncology RTOG 0618 trial[J]. JAMA Oncol, 2018, 4(9):1263-1266. DOI:10.1001/jamaoncol.2018.1251. [10] Zappa C, Mousa SA. Non-small cell lung cancer:current treatment and future advances[J]. Transl Lung Cancer Res, 2016, 5(3):288-300. DOI:10.21037/tlcr.2016.06.07. [11] Zago G, Muller M, van den Heuvel M, et al. New targeted treatments for non-small-cell lung cancer-role of nivolumab[J]. Biologics, 2016, 10:103-117. DOI:10.2147/BTT. S87878. [12] Al-Halabi H, Sayegh K, Digamurthy SR, et al. Pattern of failure analysis in metastatic EGFR-mutant lung cancer treated with tyrosine kinase inhibitors to identify candidates for consolidation stereotactic body radiation therapy[J]. J Thorac Oncol, 2015, 10(11):1601-1607. DOI:10.1097/JTO.0000000000000648. [13] Shi Y, Au JS, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology (PIONEER)[J]. J Thorac Oncol, 2014, 9(2):154-162. DOI:10.1097/JTO.0000000000000033. [14] Paez JG, Jänne PA, Lee JC, et al. EGFR mutations in lung cancer:correlation with clinical response to gefitinib therapy[J]. Science, 2004, 304(5676):1497-1500. DOI:10.1126/science.1099314. [15] Riely GJ, Kris MG, Rosenbaum D, et al. Frequency and distinctive spectrum of KRAS mutations in never smokers with lung adenocarcinoma[J]. Clin Cancer Res, 2008, 14(18):5731-5734. DOI:10.1158/1078-0432. CCR-08-0646. [16] Soria JC, Wu YL, Nakagawa K, et al. Gefitinib plus chemotherapy versus placebo plus chemotherapy in EGFR-mutation-positive non-small-cell lung cancer after progression on first-line gefitinib (IMPRESS):a phase 3 randomised trial[J]. Lancet Oncol, 2015, 16(8):990-998. DOI:10.1016/S1470-2045(15)00121-7. [17] Shi YK, Wang L, Han BH, et al. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE):a phase 3, open-label, randomized study[J]. Ann Oncol, 2017, 28(10):2443-2450. DOI:10.1093/annonc/mdx359. [18] Simon R, Norton L. The Norton-Simon hypothesis:designing more effective and less toxic chemotherapeutic regimens[J]. Nat Clin Pract Oncol, 2006, 3(8):406-407. DOI:10.1038/ncponc0560. [19] Sharma SV, Bell DW, Settleman J, et al. Epidermal growth factor receptor mutations in lung cancer[J]. Nat Rev Cancer, 2007, 7(3):169-181. DOI:10.1038/nrc2088. [20] Baumann M, Krause M. Targeting the epidermal growth factor receptor in radiotherapy:radiobiological mechanisms, preclinical and clinical results[J]. Radiother Oncol, 2004, 72(3):257-266. DOI:10.1016/j.radonc.2004.07.007. [21] Das AK, Chen BP, Story MD, et al. Somatic mutations in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) abrogate EGFR-mediated radioprotection in non-small cell lung carcinoma[J]. Cancer Res, 2007, 67(11):5267-5274. DOI:10.1158/0008-5472. CAN-07-0242. [22] Chinnaiyan P, Huang S, Vallabhaneni G, et al. Mechanisms of enhanced radiation response following epidermal growth factor receptor signaling inhibition by erlotinib (Tarceva)[J]. Cancer Res, 2005, 65(8):3328-3335. DOI:10.1158/0008-5472. CAN-04-3547. [23] Bianco C, Tortora G, Bianco R, et al. Enhancement of antitumor activity of ionizing radiation by combined treatment with the selective epidermal growth factor receptor-tyrosine kinase inhibitor ZD1839(Iressa)[J]. Clin Cancer Res, 2002, 8(10):3250-3258. [24] Guerrero E, Ahmed M. The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer[J]. Lung Cancer, 2016, 92:22-28. DOI:10.1016/j.lungcan.2015.11.015. [25] Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy:the report of AAPM task group 101[J]. Med Phys, 2010, 37(8):4078-4101. DOI:10.1118/1.3438081. [26] Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer[J]. JAMA, 2010, 303(11):1070-1076. DOI:10.1001/jama.2010.261. [27] Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ non-small-cell lung cancer:a pooled analysis of two randomised trials[J]. Lancet Oncol, 2015, 16(6):630-637. DOI:10.1016/S1470-2045(15)70168-3. [28] Kim Y, Choi I, Choi B, et al. Cyberknife frameless radiosurgery for primary or metastatic lung cancer:early preliminary report[J]. Lung cancer, 2005, 49:S310-S310. DOI:10.1016/s0169-5002(05)81222-x. [29] Iyengar P, Wardak Z, Gerber DE, et al. Consolidative radiotherapy for limited metastatic non-small-cell lung cancer:a phase 2 randomized clinical trial[J]. JAMA Oncol, 2018, 4(1):e173501. DOI:10.1001/jamaoncol.2017.3501. [30] Saunders MI, Bennett MH, Dische S, et al. Primary tumor control after radiotherapy for carcinoma of the bronchus[J]. Int J Radiat Oncol Biol Phys, 1984, 10(4):499-501. DOI:10.1016/0360-3016(84)90029-4. [31] Petrelli F, Ghidini A, Cabiddu M, et al. Addition of radiotherapy to the primary tumour in oligometastatic NSCLC:a systematic review and meta-analysis[J]. Lung Cancer, 2018, 126:194-200. DOI:10.1016/j.lungcan.2018.11.017. [32] Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma[J]. N Engl J Med, 2009, 361(10):947-957. DOI:10.1056/NEJMoa0810699. [33] Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC):a multicentre, open-label, randomised phase 3 trial[J]. Lancet Oncol, 2012, 13(3):239-246. DOI:10.1016/S1470-2045(11)70393-X. [34] Yang JJ, Chen HJ, Yan HH, et al. Clinical modes of EGFR tyrosine kinase inhibitor failure and subsequent management in advanced non-small cell lung cancer[J]. Lung Cancer, 2013, 79(1):33-39. DOI:10.1016/j.lungcan.2012.09.016. [35] Zeng J, Baik C, Bhatia S, et al. Combination of stereotactic ablative body radiation with targeted therapies[J]. Lancet Oncol, 2014, 15(10):e426-434. DOI:10.1016/S1470-2045(14)70026-9. [36] Besse B, Adjei A, Baas P, et al. 2nd ESMO consensus conference on lung cancer:non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease[J]. Ann Oncol, 2014, 25(8):1475-1484. DOI:10.1093/annonc/mdu123. [37] Weickhardt AJ, Scheier B, Burke JM, et al. Local ablative therapy of oligoprogressive disease prolongs disease control by tyrosine kinase inhibitors in oncogene-addicted non-small-cell lung cancer[J]. J Thorac Oncol, 2012, 7(12):1807-1814. DOI:10.1097/JTO.0b013e3182745948. [38] Chan O, Lee V, Mok T, et al. The role of radiotherapy in epidermal growth factor receptor mutation-positive patients with oligoprogression:a matched-cohort analysis[J]. Clin Oncol (R Coll Radiol), 2017, 29(9):568-575. DOI:10.1016/j.clon.2017.04.035. [39] Xu Q, Zhou F, Liu H, et al. Consolidative local ablative therapy improves the survival of patients with synchronous oligometastatic NSCLC harboring EGFR activating mutation treated with first-line EGFR-TKIs[J]. J Thorac Oncol, 2018, 13(9):1383-1392. DOI:10.1016/j.jtho.2018.05.019. [40] Elamin YY, Gomez DR, Antonoff MB, et al. Local consolidation therapy (LCT) after first line tyrosine kinase inhibitor (TKI) for patients with EGFR mutant metastatic non-small-cell lung cancer (NSCLC)[J]. Clin Lung Cancer, 2019, 20(1):43-47. DOI:10.1016/j.cllc.2018.09.015.