Alireza Mansouri: A Study Shares Final Results of the NRG-CC003 Randomized Phase II/III Trial
Alireza Mansouri, Associate Professor at Penn State Health, shared a post on LinkedIn about recent paper by Vinai Gondi et al., published in Journal of Clinical Oncology.
“Exciting update in oncology: The final results of the NRG-CC003 randomized phase II/III trial have been published in the Journal of Clinical Oncology, evaluating hippocampal avoidance (HA) during prophylactic cranial irradiation (PCI) for patients with small cell lung cancer (SCLC).
Although the primary endpoint for delayed recall preservation wasn’t achieved, secondary endpoints were positive, demonstrating improved cognitive outcomes with HA-PCI compared to standard PCI, without compromising overall survival or brain metastasis control. This supports HA-PCI as a potential standard of care to mitigate neurocognitive toxicities.
For those less familiar: Small cell lung cancer (SCLC) is an aggressive form of lung cancer that grows rapidly and has a high tendency to metastasize—meaning cancer cells break away and travel to distant sites, with the brain being a common target due to its rich blood supply and the cancer’s biology.
Traditionally, prophylactic cranial irradiation (PCI) is considered after initial treatment to prevent brain metastases by delivering radiation to the entire brain, even in the absence of detectable disease, as SCLC often harbors microscopic spread.
However, with advancements in imaging and treatment, there’s growing interest in a ‘watch and wait’ approach: Regular MRI surveillance to monitor for brain mets, intervening only if needed with highly effective stereotactic radiosurgery (SRS)—a precise, targeted radiation that minimizes damage to healthy tissue. This strategy aims to spare patients from PCI’s potential side effects, like cognitive decline, while maintaining outcomes, especially as SRS has proven excellent for controlling limited brain mets.
Looking ahead: Keep an eye on the MAVERICK trial (SWOG S1827/NCT04155034), a phase III study comparing MRI surveillance alone versus PCI plus MRI in SCLC patients. It’s designed to assess non-inferiority in overall survival, potentially reshaping guidelines if surveillance proves equivalent.”
Title: Hippocampal Avoidance During Prophylactic Cranial Irradiation for Patients With Small Cell Lung Cancer: Randomized Phase II/III Trial NRG-CC003
Authors: Vinai Gondi, Stephanie L. Pugh, Minesh P. Mehta, Jeffrey S. Wefel, Wolfgang A. Tomé, Alexander Y. Sun, John Grecula, Kristin J. Redmond, Shannon Fogh, Laurie Gaspar, Andre Konski, Joseph Bovi, Clifford G. Robinson, Benjamin Corn, Gregory M. Videtic, Benjamin H. Lok, Harold A. Yoon, John H. Heinzerling, Albert S. DeNittis, Ronald C. McGarry, Kiran Devisetty, Vijayananda Kundapur, Abraham J. Wu, Edward C. McCarron, Isabelle Thibault, Edmund L. Simon, Andrew M. Baschnagel, Samir Narayan, Jondavid Pollock, Rebecca Paulus, Lisa A. Kachnic
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