What if treating cancer patients with immunotherapy and radiation at the same time turns out to be more effective than either type of treatment alone? That’s the potential result that many UPMC cancer researchers currently are testing in a wide range of clinical trials.
Radiation oncologist David A. Clump II, MD, PhD, is one of the investigators. As the medical director at the Mary Hillman Jennings Radiation Oncology Center at UPMC Shadyside, he focuses on treating patients with head and neck cancers and cancers of the aerodigestive tract, including the throat, vocal cords, part of the esophagus, and windpipe. In his work as the radiation oncology co-leader of the Head and Neck Program and assistant professor at the University of Pittsburgh School of Medicine, he is known for his use of stereotactic radiotherapy to treat these cancers.
Dr. Clump sat down recently with HealthBeat to discuss how combining immunotherapy and radiation therapy in certain cancers may lead to better patient outcomes.
Q: What are stereotactic radiosurgery and stereotactic body radiotherapy and why are they so effective at treating solid tumors?
A: Our ability to deliver high-intensity, focused radiation to deep-seated targets within the body has evolved over time.
Stereotactic radiosurgery (SRS) targets tumors of the brain, usually in a single treatment session. Stereotactic body radiotherapy (SBRT) targets tumors in other body parts and organs that may be in close proximity to normal surrounding tissues. We also use the term stereotactic ablative radiation therapy (SABR), which is another name for SBRT.
All these terms describe pinpointed doses of radiation that closely conform to the tumor’s shape. This precision limits the radiation dose to surrounding tissues.
Q: What is the benefit of adding immunotherapy to radiotherapy?
A: Radiation therapy doesn’t just kill off cancer cells, it also ignites the immune system. When the tumor dies off or is affected by radiation, that breakup process allows more exposure of remaining cancer cells to the immune cells.
Immunotherapy uses the body’s own immune system to fight cancer. The therapy keeps immune cells alive longer so they can do an even better job of attacking cancer cells.
We’re now learning that the timing of when we give treatments, especially immunotherapy, is much more important than we previously thought. We now tailor the timing of immunotherapy and radiation to the type of cancer a patient has and the other treatments they’re receiving. This allows us to get the best results.
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Q: What types of cancers might benefit from combining therapies?
A: It seems likely that most if not all solid tumors might potentially have better outcomes. This includes cancers of the lung, pancreas, head, and neck, as well as advanced melanoma.
Q: What kinds of clinical trials are UPMC researchers doing to investigate these new combinations of therapies?
A: At UPMC, we have investigations that span the full range of clinical trials. These include Phase 1 trials where we evaluate novel compounds and treatments for safety. If safe, the work continues through Phase 2, where we study effectiveness, and Phase 3, where we compare new combinations with standard treatments.
And we offer many of these trials throughout the UPMC network, which makes it easier for patients to participate.
Q: What has UPMC’s history been with innovation in cancer treatments?
A: In the early 1980s, UPMC helped pioneer the Gamma Knife®, which delivers highly focused radiation or SRS to brain tumors. Later, UPMC obtained the third CyberKnife® system to ever be developed. With the CyberKnife, we were able to take what we learned in the brain and apply it to new targets like head and neck, lung, pancreas, and spine tumors.
Immunotherapy has been on a parallel timeline here because the UPMC melanoma group pioneered the use of immunotherapy starting in the early 1980s to today. As a result of the pioneering work of many UPMC researchers, we have a deep understanding of the biological responses to different treatments for tumors throughout the body.
Q: What are some other innovations for treating cancer on the horizon at UPMC?
We are currently bringing a novel treatment delivery system called RefleXion™ to UPMC. This linear accelerator integrates a positron emission tomography (PET) scanner into the treatment delivery machine to enable what is being called biology-guided radiation therapy (BgRT). BgRT uses a PET tracer at the time of treatment to accurately target tumors in real time during treatment. These images may eventually also be able to enhance our understanding of the effect of our treatment in real time. This has the potential to expand the use of radiation therapy to new indications, such as the treatment of metastatic disease, and reduce the amount of time before we know whether the treatment works.
This capability is very much in keeping with our tradition of being early technological adopters at UPMC.
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