The Signs of Ovarian Cancer are General, So Here's What to Look ForHelloGiggles
Can Meningioma Be Treated With Radiation Therapy?
Meningiomas occur more often in women than in men, especially middle-aged women. Focusing on education and timely intervention can offer hope and more effective care to those affected by this illness.Supporting structures are protected by several layers of membranes that serve as a shield against external threats. These membranes, known as the meninges, safeguard and play a role in maintaining a healthy central nervous system. Meningiomas are typically slow-growing tumours originating in the meninges, while many are benign.
Causes Of MeningiomasWhile the precise cause of meningiomas is not always apparent, certain risk factors, such as prior radiation exposure or genetic predisposition, may contribute to their development due to their potential to impact neurological function critical to reducing complications and improving the quality of life for those affected.
Commonly Known Characteristics Of MeningiomasWhen a tumour grows, symptoms can start mildly and worsen over time. They may consist of:
Meningiomas tend to grow slowly, which can make them challenging to diagnose. Medical conditions or typical signs of ageing.
Meningiomas represent a complex brain tumour category that demands thorough evaluation and customized treatment plans. It's crucial to understand the symptoms, diagnosis process, and potential treatment options to manage this condition and make informed choices increasing awareness and encouraging early detection and greater support for meningiomas. Focusing on education and timely intervention can offer hope and more effective care to those affected by this illness.
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Combining Drugs, Radiation Is 'Practice-Changing' For Some Lung Cancer Subsets
Radiation plus targeted or immunotherapies could be beneficial for certain patients with lung cancer, and expert said at the CURE® Educated Patient® Lung Cancer Summit.
"In some lung cancer patients —and other cancer types — we've realized over the last few decades that there is not one size fits all," an expert said during the summit.
Research is showing that combining radiation with targeted therapies and/or immunotherapies could be beneficial for patients with lung cancer, although ongoing studies are still determining what the best way to combine these treatment methods are, explained Dr. Percy Lee.
Lee is the medical director of Orange County Radiation Oncology, City of Hope National Medical Center. In the recent CURE® Educated Patient® Lung Cancer Summit, he discussed optimal strategies to combine targeted and immunotherapy with radiation in lung cancer.
As systemic (drug-based) treatments have become better and more personalized in recent decades, Lee said that localized therapy — meaning treatments like radiation administered directly to the site of the cancer — can play a role in ensuring better long-term outcomes.
"With increased efficacy of drug-based therapies in the past two decades, we realize that local therapy is even more important to prevent complications and reduce disease burden, and more importantly, to reduce the risk of developing clones of cells that may be resistant to future current or systemic therapy by getting rid of them with local therapy such as radiation or surgery," Lee said in his presentation.
Radiation Plus TKI TherapiesLee cited data from the SINDAS trial, which compared results of patients with oligometastatic (disease that has spread to distant parts of the body) non-small cell lung cancer who received either a tyrosine kinase inhibitor (TKI) drug alone or a TKI with radiotherapy. Of note, a TKI is a type of cancer drug that blocks specific enzymes, called tyrosine kinases, that are involved in the growth of cancer.
Findings showed that patients in the radiotherapy group tended to live longer without their disease worsening — a statistic known as progression-free survival (PFS) — compared with those who received a TKI alone. Specifically, the average PFS was 20.2 months in the TKI/radiotherapy group and 12.5 months in the TKI-only group.
Adding radiation therapy also seemed to improve overall survival (OS; time from treatment until death of any cause). Average OS was 25.5 months and 17.4 months in the radiotherapy and TKI-only groups.
More recently, findings from the phase 3 LAURA trial, which were presented at the 2024 ASCO Annual Meeting in early June 2024 showed that the TKI drug, Tagrisso (osimertinib), when given after standard chemoradiotherapy, reduced the risk of disease progression or death by 84% compared to post-chemoradiotherapy placebo in patients with locally advanced unresectable stage 3 EGFR-mutant non-small cell lung cancer (NSCLC).
"In this patient population, the goal is ideally cure, but many patients, unfortunately, are not cured from chemotherapy and radiation," Lee said. "This [data from the LAURA trial] is certainly practice-changing."
Radiation Plus Checkpoint InhibitorsResearchers are also investigating the use of immune checkpoint inhibitors with radiotherapy. The ongoing phase 3 LONESTAR trial is investigating Opdivo (nivolumab) plus Yervoy (ipilimumab) in patients with stage 4 NSCLC.
All patients on the trial will be given 12 weeks of treatment with the immunotherapy duo. Then, those who do not experience progressive disease were randomly assigned to one of two groups. The first group continues Opdivo plus Yervoy for up to two years, while the second group undergoes radiotherapy followed by Opdivo and Yervoy for up to two years.
"We'll know more as this study accrual is complete, whether there are subsets of these patients [who] would benefit from the treatment," Lee said.
The phase 3 PACIFIC trial has already shown the benefit of a checkpoint inhibitor, Imfinzi (durvalumab) given after chemoradiotherapy in patients with unresectable stage 3 NSCLC. Findings showed that in the Imfinzi group, the median PFS was 16.9 months, compared with 5.6 months in the placebo group.
"This has become the standard of care, but not all patients would benefit from this regimen if they have a mutation-driven cancer," Lee said.
Lee explained that ablative (tumor-destroying) therapies may enhance the efficacy of drugs that work by activating the patient's immune system to find and fight cancer.
"We do know that ablative treatment like radiation or other types of ablation potentially can enhance the immune system by releasing antigens, therefore educating the immune system what the foreign cancer cells might look like" Lee explained. Of note, an antigen is something that the body sees as foreign, thereby stimulating an immune response.
Sequencing Systemic Therapies and RadiationWhile radiation may boost the immune system, the treatment is a "double-edged sword," highlighting the need to figure out what the best order of therapy is, according to Lee.
"We know that radiation can increase antigen presentation and potentially stimulate the immune system and can modulate the effectiveness of anti-PD—1 therapy," he said. "But it also has intrinsic or immunosuppressive effects. T (immune) cells are very sensitive to radiation, so if you were to radiate large fields of radiation or give it with chemotherapy, that could potentially blunt the effect of immunotherapy."
This is an ongoing field of research.
Lee cited the KEYNOTE-001 study, which evaluated Keytruda after radiotherapy in patients with stage 4 NSCLC. He said that it was not clear if the combination led to more side effects.
"We're happy to report that it appears that when patients have prior Keytruda before starting Keytruda in this setting, they appear to have a longer [PFS] and [OS] in these cohorts," Lee said.
As researchers continue to investigate the combination of systemic cancer therapy and radiation, it's likely that there will not be one perfect method that will work for everyone, according to Lee.
"In some lung cancer patients — and other cancer types — we've realized over the last few decades that there is not one size fits all," he said.
For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.
ASTRO Guideline Addresses Specifics Of HPV-Associated Oropharyngeal Cancer
Responding to the changing clinical landscape of head and neck (H&N) cancer, the American Society for Radiation Oncology (ASTRO) has developed recommendations specific to HPV-positive oropharyngeal cancer.
The incidence of H&N cancer associated with alcohol and smoking has declined in recent years, and HPV-positive disease now accounts for approximately 70% of new cases, particularly oropharyngeal squamous cell cancer (OPSCC). With curative-intent radiation therapy for OPSCC, ASTRO recommends systemic therapy (preferably containing cisplatin), in addition, for patients with high-risk features, such as large tumors or involvement of multiple lymph nodes. Patients who are not candidates for cisplatin may receive cetuximab (Erbitux) or carboplatin/5-fluorouracil.
"This guideline is restricted to HPV-associated oropharyngeal cancer, whereas the previous [2017] guideline applied to both HPV-negative and HPV-positive oropharyngeal cancer," said guideline co-chair David Sher, MD, of the UT Southwestern Medical Center in Dallas. "Several new prospective trials have since been published that were incorporated into this guideline (such as the randomized trials of cetuximab)."
"This guideline provided additional recommendations on treatment volumes, treatment technique, normal tissue considerations, as well as initial patient reassessment following primary treatment," he added.
Uniquely, the guideline has specific radiation doses for normal tissues in patients who receive radiation therapy to just one side of the neck, added co-chair Danielle N. Margalit, MD, of Dana-Farber Cancer Institute in Boston.
"This helps to encourage radiation oncologists to get to the minimal dose possible to patient normal tissues," she told MedPage Today via email. "I am not aware of any other guideline that provides dose limits for unilateral treatment."
Other noteworthy aspects of the guideline include:
Throughout the guideline, recommendations emphasize shared decision-making with patients. The guideline is publicly available in the current issue of Practical Radiation Oncology.
Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow
Disclosures
Sher disclosed a relationship with Varian.
Margalit reported no relevant financial disclosures.
Primary Source
Practical Radiation Oncology
Source Reference: Margalit DN, et al "Radiation therapy for HPV-positive oropharyngeal squamous cell carcinoma: An ASTRO clinical practice guideline" Pract Radiat Oncol 2024; DOI: 10.1016/j.Prro.2024.05.007.
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