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The Front Line
The Front Line: Charles D. Blanke, MD, SWOG Chair

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Lung Cancer Takes Center Stage in Clinical Trials

Sep 11, 2015 - By any measure, S0819 was a big deal for SWOG. This lung cancer study was open for five years, with 1,313 patients enrolled.

And lots of SWOG intellectual firepower went into S0819.

Dr. Roy Herbst of Yale, a senior member of the SWOG Lung Committee, served as principal investigator. Dr. David Gandara, our Lung Committee chair from UC Davis, was instrumental. The University of Colorado's Dr. Fred Hirsch, long-time SWOG member, played a key role in the translational aspects of the trial. Finally, Dr. Mary Redman of the Fred Hutchinson CRC, lead statistician of SWOG's Lung Committee, brought her excellent skills to bear in S0819.

Results from this impressive effort were released this week in a plenary talk at the 16th World Conference on Lung Cancer. Dr. Herbst stood on stage in Denver before a big crowd to issue several important findings: The addition of cetuximab to chemotherapy showed no benefit for the overall population of patients with advanced non-small cell lung cancer. But the addition of cetuximab made a big difference for some.

Results from a planned S0819 sub-analysis showed that cetuximab reduced the risk of death by 44% -- median overall survival improved from 6.4 to 11.8 months -- for patients with advanced squamous cell cancer whose tumors test positive for EGFR gene amplification. EGFR positivity was measured by fluorescent in-situ hybridization, or FISH, in a technique perfected in the Hirsch lab.

At the plenary, and in a press conference, Herbst said the data support using such testing to select patients to receive antibody therapies targeting EGFR.

"Squamous cell carcinoma is a subtype of lung cancer for which we have seen few new targeted therapies in the last 20 years," Dr. Herbst said. "These data provide us with a biomarker than can be used with cetuximab or similar drugs in the future."

In many ways, S0819 was a forerunner to what SWOG and other groups are doing, within the field of lung oncology, and in other places.

It used genetic tools and, of course, focused on lung cancer. Today, two out of the three NCI precision medicine trials -- SWOG's Lung-MAP and ECOG-ACRIN's ALCHEMIST trials -- use genetic profiling to study lung cancer treatments. The third, NCI-MATCH, is using DNA screening to study several cancers, including lung.

S0819 benefits those we serve: our patients. It accrued via members of several NCTN groups. Thus, it illustrates something important: the essential nature of collaboration in today's cancer trials. As Dr. Gandara himself said: "This shows the power of cooperative groups."


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