Exploring Palliative and Curative Radiation for Lung Cancer

Radiation for lung cancer is typically given in one of two settings: to relieve symptoms or with curative intent for unresectable disease, according to Dr. Jared Weiss during an interview with CURE.

For palliative care, the goal is comfort, such as treating painful bone metastases or easing breathing issues from airway compression. In contrast, curative radiation is used in cases like unresectable stage 3 lung cancer, typically delivered over several weeks to a large area of the chest for safety.

A newer form of radiation, called hypofractionated radiation or stereotactic body radiotherapy (sometimes by brand names like CyberKnife), involves giving a high dose to a small area in fewer sessions. This is where JNJ-1900 comes in — designed to work with these shorter, targeted treatments. Unlike traditional chemotherapy-based radiation sensitizers, JNJ-1900 not only boosts the effect of radiation at the site but also helps trigger immune responses that may lead to further antitumor activity elsewhere in the body.

Weiss is the section chief of Thoracic and Head/Neck Oncology at the UNC Lineberger Comprehensive Cancer Center, located in Chapel Hill, North Carolina. Weiss also serves as a professor of medicine in the Department of Medicine, Division of Oncology, at the UNC School of Medicine.

Transcript:

Traditional radiation for lung cancer is given in one of two contexts: either you have a spot that's a particular problem and you're giving the radiation to palliate, or you're giving it for unresectable disease with a goal of cure. For the former situation, a classic example might be a painful bony met (bone metastasis) where your goal of the radiation — you know you're not curing the person, you're not even extending survival — but you're trying to relieve pain at that site of the bony met. Another example might be a patient who has cough, trouble breathing from compression of a central airway, where your goal is to open that airway. Purely palliative — it's for comfort.

Whereas in the unresectable stage 3 disease, you're looking to cure people. JNJ-1900 is meant to work with hypofractionated radiation. Let's translate that into plainer English.

When you give curative intent radiation — when you're treating a big area in the chest — you're treating it over seven weeks, you break up that dose. Because you're treating such a large area, you need to do that for safety. So you're giving your total dose over six, six-plus weeks. That's traditional fractionation.

There's a new form of radiation, sometimes referred to by brand names like CyberKnife. Other names are stereotactic body radiotherapy or hypofractionated radiation, whatever you want to call it. That's the camp of radiation that 1900 is meant to work with — when you're giving a burst of radiation to a very small focal area in one or a very small number of sessions. And so you're not going to treat with JNJ-1900 a huge central tumor mass. You're going to treat a much smaller area.

Thus far, a lot of the data on it are really centered around its use more as an immune-stimulating agent than as a traditional radiation sensitizer like chemo, per se. It is a radiation sensitizer — it's a very potent one. That area that you deliver a small dose of hypofractionated radiation to, you're going to fry it. But what's truly special about 1900 isn't just that it's a radiation sensitizer — it's the downstream sequelae of that radiation sensitization for immune stimulation.

Transcript has been edited for clarity and conciseness.

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