Metastatic cancer is responsible
for 90% of cancer deaths

Metastatic cancer is responsible for 90% of cancer deaths worldwide. Non-small cell lung cancer (NSCLC) comprises 85% of all lung cancer cases. The majority of patients are diagnosed at the time of metastatic disease (stage IV), when treatment options are limited and 5-year survival rates are drastically reduced (<6% in stage IV). These patients nearly always develop multidrug resistance to many forms of chemotherapy and targeted agents or immunotherapy work only in a fraction of patients.

At present, a significant minority of lung cancer patients benefit from immunotherapy, which remains not curativein most of the cases. These patients mainly rely on palliative treatment with a combination of systemic cytotoxic chemotherapy, immunotherapy and/or targeted agents. Current treatment strategies result in an unsatifactory median progression-free survival (PFS). These figures call for a major transformation of the current thinking and therapeutic management of metastatic cancer.

Additional metastases

Most patients with limited metastatic disease can be treated with some significant benefits by stereotactic radiotherapy (see for example Gomez et al. JCO 2016) but develop additional metastases outside the irradiated volume within months of treatment, due to the presence of micrometastases undetectable with current imaging techniques. This underlines the need for a powerful bi-modal treatment synergy with an effective systemic therapy.

A 1+1=3 combination

ImmunoSABR combines two treatment strategies: stereotactic radiotherapy (SABR) and immunotherapy, a “1+1=3” combination. Clinical studies on immunotherapy have shown increasingly good responses. Immunotherapy is also standard of care in certain conditions as a first line or second line treatment. SABR and immunotherapy are a “1+1=3” combination, by first providing, in several preclinical models) a strong synergistic and complementary effect by exploiting the clinical detectable cancer lesions as an ‘in situ’ vaccine by SABR in order to enhance systemic anti-tumour immune responses to target synchronous micrometastases, and second boosting effective tumour-specific immunity for long term tumour control (the so-called “memory effect”).

Objective of Immuno SABR

NSCLC is an immunosensitive disease. Therefore, patients with limited metastatic NSCLC might be the first subgroup of patients to benefit from this novel approach to cancer therapy.
The main objective of ImmunoSABR will be to obtain clinical proof of concept for our bi-modal curative treatment strategy, by conducting a randomised phase II clinical trial in patients with less then 10 metastases from Non Small Cell Lung Cancer. We hypothesized ImmunoSABR will prolong progression-free survival (PFS) while maintaining quality of life and at the price of only mild, transient toxicity.

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