Atezolizumab SBRT S1914 SWOG Phase 3 Results 
Does Atezolizumab SBRT Improve Progression-Free Survival In NSCLC?
Atezolizumab is an immune checkpoint inhibitor that targets PDL-1. It has been studied in a number of solid tumors, including non-small cell lung cancer, and is an approved treatment for non-small cell lung cancer that has spread to other parts of the body. It was also recently found to improve progression-free survival in patients with early-stage non-small cell lung cancer whose cancer had been removed. So, in S1914, we're testing to see if adding neoadjuvant, concurrent, and adjuvant Atezolizumab SBRT (stereotactic body radiation therapy) randomized phase III trial for people with early-stage non-small cell lung cancer that can't be operated on will increase overall (progression-free) survival.
5 Key Takeaways from the Atezolizumab SBRT Clinical Trial
To investigate the difference in overall survival (OS) between patients randomized to stereotactic body radiation therapy (SBRT) usual radiation therapy works with or without atezolizumab (which helps the body's immune system attack the cells) who had inoperable early-stage non-small cell lung cancer (NSCLC).
To evaluate the difference in progression-free survival (PFS) between the two treatment arms using blinded independent centralized review (BIRC) in a sample of patients chosen at random.
To compare the quality of life between the two groups using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-30 and the EORTC-QLQ- Lung Cancer Questionnaire (LC13).
On day 1 of each cycle, patients are given atezolizumab intravenously (IV) for a period of thirty to sixty minutes. In the absence of disease progression or intolerable toxicity, the treatment will be repeated every 21 days for a total of eight cycles. Patients also get SBRT beginning on day 1 of cycle 3, which consists of 3-8 treatments administered every 2 days for 1-3 weeks. In addition, patients have their blood drawn after randomization and before treatment, once a week after SBRT is finished, after 18 weeks, and again when the disease worsens.
Patients undergo SBRT beginning 21 days after they have been randomly assigned treatment, with 3-8 sessions administered every 2 days for 1-3 weeks. In addition, patients have their blood drawn after randomization and before treatment, once a week after SBRT is finished, after 18 weeks, and again when the disease worsens.
What Is The Current Standard Of Care For Patients With Non-Small Lung Cancer (NSCLC)? And Why Was Atezolizumab SBRT (stereotactic body radiation therapy) Chosen For This Randomized Phase III Trial?
The patient population that we're evaluating in S1914 in randomized phase III trial by the National Cancer Institute in patients with medically inoperable early stage non-small cell lung cancer, and the current standard of care for early stage medically inoperable non-small cell lung cancer is SBRT (atezolizumab and usual radiation therapy), or Saber, which is a type of stereotactic radiation that's used in place of surgery for treating patients who cannot have surgery, and SBRT has high rates of controlling the tumor (cells) at the site where it's treated.
But there is a pretty high chance that the cancer will come back in the same place or somewhere else, especially in people whose tumors are bigger or more aggressive biologically. Many people with non-small cell lung cancer that can't be removed by surgery don't do well with chemotherapy, and this group of people hasn't been studied much when it comes to chemotherapy.
But immunotherapy, which is usually better tolerated, was what we were really interested in. It is easy for us to use and easy for our patients to handle, and it has shown promise in the early stages of receptive disease. So, we hope that adding Atezolizumab SBRT (stereotactic body radiation therapy randomized phase III trial) will cut down on local and faraway recurrences, which could lead to better overall (progression-free) survival.
What Is The Design Of The Atezolizumab SBRT (Stereotactic Body Radiation Therapy) Clinical Trial?
S1914 is a randomized phase III trial. So, we plan to randomly assign each patient to either the standard of care, which is just stereotactic radiation, or the experimental arm, which includes neoadjuvant, concurrent, and adjuvant atlizumab.
In the experimental group, patients get a total of eight cycles of atlizumab over the course of six months, and to deliver radiation, it starts with the third cycle. Huge steps forward have been made with the invention of stereotactic radiation, which is now a treatment for early-stage lung cancer patients who cannot be operated on and who need to be cured. Huge steps forward have been made Patients and huge steps forward have been made with the invention of stereotactic radiation, which is now a treatment for early-stage lung cancer patients who cannot be operated on and who need to be cured. There is mention of stereotactic radiation, which is now is treating patients for early-stage lung cancer who cannot be operated on and who need to be cured to help with overall survival.
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What Were The Specific Inclusions And Exclusions Of The Trial?
Patients who are eligible for S1914 have early-stage non-small cell lung cancer that is medically untreatable and at least one risk factor that suggests they are more likely to have their cancer come back locally or far away.
And these include a tumor (cells) diameter of at least two centimeters, or they can be eligible based on the tumor (cells) SUV or grade. We do allow up to T3 tumors to enroll, and we allow multifocal tumors. So it's relatively broad, pragmatic eligibility.
What Are Your Hopes For The Use Of Atezolizumab SBRT (Stereotactic Body Radiation Therapy) In Patients With Non-small Cell Lung Cancer (NSCLC)?
We hope that adding Atezolizumab to stereotactic radiation in this group of patients will increase overall survival and reduce the number of times the disease comes back.
What Led You To Study Non-small Cell Lung Cancer (NSCLC)?
So I'm a radiation oncologist who specializes in the study treatment of lung cancer. I finished my residency about 11 years ago, and I've been working at UC Davis for most of that time. And I've been focused on lung cancer for most of that time period. And this, to me, is a wonderful patient population to work with.
It's a patient population where we still have a lot of work to do in terms of approving outcomes. Lung cancer (overall) survival is not where we need it to be, so it's been a very rewarding space to try. In the last 20 to 25 years, thoracic radiation oncology has come a long way. Huge steps forward have been made with the invention of stereotactic radiation, which is now a treatment for early-stage lung cancer patients who cannot be operated on and who need to be cured.
And I think trying to figure out ways of further reducing those patients' recurrences and improving their overall survival is the next logical step and an important thing that we need to do.
Final Thoughts On Atezolizumab SBRT (Stereotactic Body Radiation Therapy) Clinical Trial Results
If you have early-stage lung cancer that can't be treated with surgery, I urge you to join S1914 or one of the other randomized phase III trial in this area. Looking at the addition of immunotherapy, these are patients who I think are oftentimes underserved by clinical trials, and we really want to make sure that we're optimizing treatment for this patient population for their overall survival.
Megan Daly, MD - About The Author, Credentials, and Affiliations
Dr. Megan Daly practices at US Davis and believes in aggressively treating cancer while preserving the health and quality of life of her patients. She believes that the treatment of cancer is a collaboration between the patient and the team of specialists providing care. Her objective is for patients to comprehend all treatment alternatives and be entirely at ease with their treatment decisions.
Dr. Daly specializes in the treatment of thoracic cancers, lymphoma, breast cancer, and cancers of the head and neck. She is an expert in numerous radiotherapy procedures, including stereotactic body radiotherapy (SBRT), intensity modulated radiation therapy (IMRT), and image guided radiation therapy (IGRT).
Dr. Daly's research focuses on the application of stereotactic body irradiation for the treatment of early-stage lung cancer, metastatic lung lesions, and primary and metastatic spine cancers. She is especially interested in head and neck cancer research, particularly the utilization of improvements in image guidance and conformal therapies to allow dosage escalation while sparing normal tissues and minimizing the side-effect profile of radiation therapy.