Adding tumor-treating fields therapy to standard treatment improves overall survival in patients with metastatic non-small cell lung cancer (NSCLC), according to results from the LUNAR trial published in The Lancet Oncology.
In this phase 3 trial, patients who received tumor-treating fields therapy and standard therapy had a 26% lower risk of death than patients treated with standard therapy alone.
The trial (ClinicalTrials.gov Identifier: NCT02973789) included 276 patients with metastatic NSCLC whose disease had progressed on or after platinum-based therapy.
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The patients were randomly assigned to tumor-treating fields plus standard systemic therapy (n=137) or standard systemic therapy alone (n=139). Standard therapy consisted of investigators’ choice of an immune checkpoint inhibitor (nivolumab, pembrolizumab, or atezolizumab) or docetaxel. Tumor-treating fields therapy (150 kHz) was delivered to the thoracic region, and the recommendation was for patients to receive it for an average of at least 18 hours per day.
Baseline characteristics were similar between the treatment arms. The median follow-up was 10.6 months in the tumor-treating fields arm and 9.5 months in the standard therapy arm.
The median overall survival was 13.2 months in the tumor-treating fields arm and 9.9 months in the standard therapy-alone arm (hazard ratio [HR], 0.74; 95% CI, 0.56-0.98; P =.035). The 1-year overall survival rate was 53% and 42%, respectively.
There was no significant difference in progression-free survival or overall response rate between the treatment arms. The median progression-free survival was 4.8 months in the tumor-treating fields arm and 4.1 months in the standard therapy-alone arm (HR, 0.85; 95% CI, 0.67–1.11; P =.23). The overall response rate was 20.4% in the tumor-treating fields arm and 17.3% in the standard therapy-alone arm (P =.50).
Serious adverse events (AEs) of any cause were reported in 53% of patients in the tumor-treating fields arm and 38% of patients in the standard therapy-alone arm. Grade 3-5 AEs occurred in 59% and 56%, respectively.
“[T]here was no specific event or class of events that appeared to occur more frequently in either group,” the researchers noted.
Serious AEs related to standard therapy occurred in 19% of patients in the tumor-treating fields arm and 15% of those in the standard therapy-alone arm. Serious AEs related to tumor-treating fields therapy occurred in 3% of patients in that arm.
The most common AEs related to tumor-treating fields therapy were grade 1-2 dermatitis (39%), pruritus (12%), rash (9%), and skin ulcers (8%). There were no grade 4 AEs attributed to tumor-treating fields therapy.
“The overall survival benefit with TTFields [tumor-treating fields] therapy occurred without exacerbating the toxicities associated with systemic therapies,” the researchers wrote. “These pivotal efficacy and safety data suggest that TTFields therapy should be considered as a treatment option to manage the disease in this setting.”
Disclosures: This research was supported by Novocure. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Leal T, Kotecha R, Ramlau R, et al. Tumor-treating fields therapy with standard systemic therapy versus standard systemic therapy alone in metastatic non-small-cell lung cancer following progression on or after platinum-based therapy (LUNAR): A randomised, open-label, pivotal phase 3 study. Lancet Oncol. 2023;24:1002-1017. doi:https://doi.org/10.1016/S1470-2045(23)00344-3
This article originally appeared on Cancer Therapy Advisor
