Targeted therapy combined with thoracic radiotherapy for non-small cell lung cancer

IntroductionIn recent years, there has been undoubted progress in the evaluation and development of targeted agents for non-small cell lung cancer (NSCLC). At the same time, remarkable progress in radiation therapy (RT) has been developed largely due to our ability to more effectively focus and deliver radiation to the tumor target volume. Both developments brought the idea of combining the radiation with molecularly targeted agents in order to improve outcomes in NSCLC patients who have limited survival times with standard chemoradiotherapy.MethodsWe identified patients with gastric cancer treated with post-operative radiation at our institution between 2002 and 2016. Acute and late toxicities were evaluated per RTOG/EORTC Radiation Toxicity Grading Scale. Statistical analysis was performed using Chi-square tests, t tests, log-rank, and logistic regression.ResultsCetuximab has no survival benefit, and it seems to be toxic in this patient population. Bevacizumab has severe toxicity including tracheoesophageal fistulae formation in addition to its ineffectiveness. It is difficult to have an opinion about TKIs when combined with RT since most of the studies were conducted on unselected patients. For oligometastatic/oligoprogressive NSCLC patients, it seems to be reasonable to use a combined regimen since combined regimen resulted in superior survival time; however, the patients should be followed up closely with respect to the toxicity. In patients with brain metastases, the use of concomitant RT + TKIs increased survival with acceptable toxicity levels.ConclusionsIn this review, we summarize the recent literature about the use of molecularly targeted agents with concurrent RT in NSCLC patients.