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Center Research Updates in Gastrointestinal, Lung and Head & Neck Cancers

Center Research Updates in Gastrointestinal, Lung and Head & Neck Cancers

This month, we update cancer research and treatment in lung, gastrointestinal, and head and neck cancers. We spoke to some of our disease experts who weighed in on the latest and greatest.

Dr. Apisarnthanarax is the Clinical Research Director at UW Medicine's Department of Radiation Oncology and supervises any clinical studies and research within the department, oversees the assessment and prioritizing of clinical research resources, and manages the opening and monitoring of clinical trials. As one of our Center's gastrointestinal cancer experts, he updates us on a few promising studies in the field.

"I'm especially excited about the proton vs photon esophageal trial that we have open here. There is promising data that suggests proton therapy may result in improved patient outcomes compared to traditional photon radiation, and this randomized study will help us confirm this potential benefit," says Dr. Apisarnthanarax. "There is also another large randomized study for hepatocellular carcinoma - a type of liver cancer - that also is looking at this same question."

There is also a clinical trial for liver cancers that is open at the Center. The trial looks at the use of functional imaging scans to visualize the normal liver tissue so that we can improve radiation targeting to make it safer and potentially more effective. This is important because many liver cancer patients also have cirrhosis, making it challenging to deliver radiation to the liver without harming normal liver function.

Thoracic cancer experts Dr. Jing Zeng, our Medical Director, and Dr. Ramesh Rengan, Chair of the UW Department of Radiation Oncology and Professor in the Clinical Research Division of the Fred Hutchinson Cancer Research Center, are both running clinical trials that look at improving radiation treatment for inoperable lung cancers.

Dr. Zeng is the principle investigator on numerous proton therapy studies, including the Functional Lung Avoidance & Response-adaptive Escalation (FLARE) Radiation Therapy trial, which tries to determine if we can better predict the exact amount of radiation a patient needs by assessing tumor response on a scan halfway through radiation treatment. If the scan shows significant tumor shrinkage, treatment continues as planned; if the tumor is not shrinking quickly enough, doctors intensify the radiation dose for the second half of treatment. Such adjustments may help to improve survival. All patients on the trial also undergo functional lung imaging to avoid radiating healthy parts of the lung. This will hopefully decrease the risk of lung damage from radiation. 

"This is an important step toward personalized medicine in the sense that right now, we give everyone the same treatment, but we realize that's too much treatment for some patients and not enough for others," says Dr. Zeng. "We are excited to start figuring out when it is enough." The trial looks at both proton therapy patients and patients treated with conventional radiation delivered with X-rays.

Dr. Rengan's Adaptive-Dose to Mediastinum with Immunotherapy and Radiation in Locally-advanced non-small cell lung cancer (ADMIRAL) trial will examine whether targeted radiation will help chemotherapy and immunotherapy kill cancer cells. If so, patients with inoperable lung cancer might need less radiation overall.  All patients on the clinical trial will get chemotherapy and immunotherapy plus focused radiation to one site of cancer. If the patient has a good response to this – meaning all areas of cancer shrink and disappear – the patient may be able to avoid further radiation to the chest, which can increase toxicity to the heart, lung, and esophagus. In other words, the trial looks at using radiation almost like a vaccine to kick-start the patient's immune response, which in turn would take care of the smaller tumors without further radiation.

"This “biologically directed” anti-cancer treatment is already a reality for several malignancies, including leukemia and lymphoma. In my lifetime, I would like to see this approach integrated across all solid tumors, including lung cancer and melanoma," says Dr. Rengan.

The ADMIRAL trial will open at the SCCA Proton Therapy Center shortly, and plans are for about half of an estimated 40 participants to receive proton therapy. If results are encouraging, doctors hope to start a nationwide randomized trial. Both trials are important studies to determine how to cure lung cancer with the least necessary radiation dose to the patient's body.

Our head and neck team includes Dr. George Laramore, our former Medical Director and the person who spearheaded the effort to bring proton therapy to the state.  Dr. Laramore and team recently published results of a study focusing on oropharyngeal cancer showing that proton therapy can decrease acute and late toxicity in oropharyngeal squamous cell cancer (OPSCC) when compared with conventional therapy. Oropharyngeal cancer is the most common type of head and neck cancer in the US.

"Individualization of treatment according to patient prognosis is an area of increasing interest," says Dr. Laramore, "particularly in terms of de-intensifying the treatment. For example, we study the best way to reduce the postoperative radiation dose in patients with oropharyngeal tumors related to the human papilloma virus. Early-stage tonsil cancers and salivary gland tumors can also benefit."

The results of the team's other study on providing a proton therapy boost after neutron therapy for nasopharyngeal cancer is being published right now. UW Medicine is the only facility in the United States with access to both neutrons and protons. Dr. Laramore is one of the world leaders in the study of clinical neutron therapy.

For more information on clinical trials open at our Center, click here