Australian oncologist leads new treatment approach in advanced lung cancer

Lung cancer is the leading cause of cancer-related death and the second most common cancer in both men and women in Australia and worldwide. An Australian phase III trial is set to explore whether targeting the primary tumour with radiotherapy in metastatic non-small cell lung cancer (NSCLC) can reduce further disease spread and synergise with standard-of-care chemo/immunotherapies.

Melbourne-based radiation oncologist Professor Shankar Siva has been awarded a $1.5 million MRFF grant to lead the Primary Radiotherapy in Metastatic Lung (PRIME-Lung) study, spanning 17 sites and leveraging the data infrastructure of the AURORA lung registry.

“Current treatment strategies in advanced lung cancer rely on drug treatments, however, patients inevitably develop resistance to treatment, so we need to explore alternatives,” explained Professor Siva.

“We believe that when we eradicate the primary tumour with radiotherapy we also enhance the impact of drug treatments and prevent further spreading of cancer to other sites.”

NSCLC accounts for 85% of all lung cancer cases. Outcomes remain poor once the disease has metastasised, with over half of patients diagnosed at this advanced stage. For many, survival is less than two years.

While radiotherapy has improved survival outcomes in other cancers, its use in advanced lung cancer remains largely unexplored.

“Studies in other cancers have shown that non-invasive radiotherapy to the primary tumour, even when the cancer has spread to other areas, improves patient survival,” he said. “Our project, PRIME-Lung, will test for the first time if this strategy is effective in lung cancer too.”

Meanwhile, another frontier of research gaining momentum is cancer vaccines, spurred on by promising results in melanoma and pancreatic cancer.

In Australia, the only lung cancer vaccine currently in clinical trials is MSD and Moderna’s mRNA-4157, also known as the V940 vaccine. It is being tested through two phase III trials – INTerpath-002 and INTerpath-009 – which evaluate the vaccine’s potential when added to pembrolizumab in the adjuvant treatment of NSCLC.

Globally, several vaccine trials targeting lung cancer are underway. Among the most prominent is BioNTech’s BNT116 vaccine, currently being studied in combination with cemiplimab, a PD-1 inhibitor, as part of the EMPOWERVAX Lung 1 trial, as well as with other drug regimens or as monotherapy in the LuCa-MERIT-1 trial.

The pipeline also includes efforts in mesothelioma, with the UV1 peptide-based vaccine being tested alongside ipilimumab and nivolumab in a phase II trial that includes Australian sites.

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