Oncology Frontier: Could you outline the findings from the phase III NVALT study?

Dr. Belani: The NVALT study is not going to change overall practice in lung cancer， but what the investigators have shown in this trial is that giving prophylactic cranial irradiation in patients who have received definitive treatment for non-small cell lung cancer combining chemotherapy， radiation with or without surgery， shows a benefit in reducing the incidence of brain metastases. It reduces both symptomatic and asymptomatic brain metastasis. But the overall survival is not impacted， even though there is a delay in occurrence of brain metastases by giving prophylactic cranial irradiation. In the short term though， there may be a reduction in the quality of life because of neurological symptoms related to the prophylactic cranial irradiation. I think we are on the right path. It was a phase III study and it reduced the incidence of brain metastases， and that is an advantage.



Oncology Frontier: What results at this meeting will change lung cancer practice?

Dr. Belani: At this point in time， we have multiple presentations on lung cancer. What we have seen is that in small cell lung cancer， patients with extensive disease who receive consolidation radiation therapy show a benefit especially if there is a single area that is progressing. In our meta-analysis， we showed there was a benefit to giving consolidation radiation therapy after there had been a significant response to chemotherapy for extensive stage disease. The significant things coming out of this ASCO meeting are immunotherapy and immunotherapy combinations. Immuno-oncology (I-O) and I-O combinations will be of immense benefit especially in patients who do not have PD-L1 overexpression. One such combination would be the IDO inhibitor， epacadostat， combined with pembrolizumab， which shows a 39% response rate in patients with advanced non-small cell lung cancer who had received 0-2 prior lines of therapy. Though PD-L1 expression does signify increased activity with PD-1 and PD-L1 inhibitors， mutational burden and creation of an inflammatory environment can lead to improvements in outcomes. We are getting there; we are not there yet， but it is an exciting time. We have a tail end on the curve in most studies， which means we are seeing long-term survivals even in stage 4 NSCLC. But the hope is that we can cure lung cancer one day.

宾夕法尼亚州赫尔希癌症研究所Chandra Prakash Belani， MD在本刊记者采访点评了III期NVALT11研究结果。

Chandra Belani：2017 ASCO报道的III期NVALT11研究结果不会改变肺癌整体临床实践。这项研究的主要终点为出现有症状脑转移（sBM）的患者比例。研究发现对于同步或序贯放化疗±手术后的III期NSCLC患者，预防性颅脑照射（PCI）显著降低了sBM的发生率，包括有症状脑转移和无症状脑转移。但对患者的OS没有影响。由于PCI的神经毒性，PCI降低了患者3个月的生活质量，但对之后的生活质量没有影响（摘要编号8502）。我认为这个治疗思路是正确的，这项III期研究证明了PCI可降低脑转移的发生率，这是一个优势。

对于哪些研究能改变临床实践这个问题，今年ASCO报告了诸多有影响力的研究。一项研究发现，对于化疗治疗有效的广泛期小细胞肺癌，给予巩固放疗能使患者获益。免疫治疗和免疫联合治疗是本次ASCO会议的重点。其中，在ECHO-202/KEYNOTE-037研究中，既往接受过0~2线治疗的晚期NSCLC患者经IDO抑制剂Epacadostat+Pembrolizumab治疗后的客观应答率（ORR）为39%（14/36）(摘要9014)。我们正在不断取得进步，目前医学进步已经让一些IV期患者获得长期生存，但我们的愿望是有朝一日能治愈肺癌。