Journal Club

Development of drug-radiotherapy combinations


The development of Radiation Oncology and Medical Oncology as two distinct specialties may deprive our patients of some important synergies. The addition of drugs to radiotherapy to enhance effect has been described since at least 1968 (initially with 5FU) and the use of platinum agents in the curative protocols for squamous cell cancers has been long established. A small academic quarrel broke out a few years ago between those who would refer to the paradigm as ‘chemoradiotherapy’ or ‘radiochemotherapy’ depending on attitudes towards relative importance!


Adding drugs may improve outcomes either through spatial cooperation, synergy or improved therapeutic ratio. The much discussed abscopal effect seen (only very rarely) with modern immunotherapies adds another intriguing possibility.


Despite these potentials and the proven track record of drugs like Cisplatin and more recently Cetuximab there is little enthusiasm in industry for testing new combinations or agents in radiotherapy. Pharma may be put off what they see as overly short (and less profitable) treatment regimens but also the complexities of testing agents reliably.


In this context the National Cancer Research Institute (NCRI) Clinical and Translational Radiotherapy Research Working Group (CtRAD) formed a working group to challenge stakeholders to upset the status quo and to do so with clear consensus as to how drug combinations with radiotherapy should be tested.


This consensus statement (published in Nature Review Clinical Oncology) will be discussed at the next #radonc journal club at 6pm GMT (1 pm CST) on Sunday 24th July. Joining the discussion will be outgoing CtRAD Chair Prof David Sebag-Montefiore (@MontefioreD) from Leeds and current Chair Prof Anthony Chalmers (@ProfAJChalmers) from the Beatson, Glasgow.


The paper is open for comment all weekend but the live chat on Sunday will centre around 4 questions:


T1: What was the motivation to produce a consensus document and who are the stakeholders?

T2: What classes of drugs show most promise in drug-radiotherapy combination?

T3: What standards need to be set in testing drug – radiotherapy combinations?

T4: What are the roles of Industry and researchers in promoting this research agenda?


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  • T1.Surely the motivation for consensus is to ensure all.patients get the best treatment available as well as focussing limited resources on improving treatments, e.g. clinical trials.
    Patients should be included as stakeholders and now would be a good time to ask past and current patients as pathways are changing in the uk. Pathways changing due to changing ratio of clin and med oncologists.
    As a radiographer I’d like to see consensus to cover order of and timing of treatments.
    Does it matter if you give chemo or Radio first?
    Do all chemoRt regeimes need to start on a Monday?
    I’d also suggest that we ensure we can’t deliver the benefits of chemoRt by giving RT differently or using non cytotoxic drugs?
    In scc h&n what is the difference in benefit between giving chemort or giving 6#/week and what is the difference in cost? What do patients prefer?
    Another example is in bladder ca. why give chemo concurrently when you get similar results with carbogen and nicotinomide for a fraction of the cost?
    I think there is also a need to join up staff & share knowledge about treatments combinations for staff deliverying combinations.
    What recommendations would we want around deliverying concurrent treatments on different geographic sites/ different trusts.

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