Yonsei Cancer Hospital Expands Carbon Ion Therapy to Stage IV Oligometastatic Lung Cancer
核心洞察
Yonsei Cancer Hospital (搜索) is extending carbon ion therapy beyond early-stage non-small cell lung cancer (搜索) to patients with stage IV oligometastatic lung cancer (搜索), where metastatic lesions are limited.
Prior phase III trials show combining EGFR (搜索)-targeted therapy with radiation extended progression-free survival from 12.5 to 20.2 months and overall survival from 17.4 to 25.5 months.
A Korean multicenter phase II study combining lazertinib with stereotactic body radiotherapy achieved a median progression-free survival of 34 months with no grade 3 or higher radiation pneumonitis.
Yonsei Cancer Hospital (搜索) announced on September 7 that it will expand carbon ion therapy—previously focused on early-stage non-small cell lung cancer (搜索)—to patients with stage IV oligometastatic lung cancer (搜索), a setting in which cancer has spread to other organs but the number of metastatic lesions remains limited.
Carbon ion therapy is a form of radiation treatment that accelerates heavy particles, specifically carbon ions, to extremely high speeds and directs them at cancer cells. The approach reduces the radiation dose delivered to normal tissues, lowering the risk of damage, while concentrating high-energy radiation on cancer cells to effectively destroy them. This not only limits damage to normal lung tissue but also reduces radiation exposure to neighboring organs such as the heart and esophagus.
Rationale for Expanding Local Therapy in Stage IV Disease
Once cancer has spread to other organs, it is classified as stage IV. However, even within stage IV, treatment strategies can differ depending on whether the cancer is widely disseminated across multiple organs or confined to a limited number of lesions. Studies have reported that in oligometastatic lung cancer (搜索), where the number of metastatic lesions is small, combining systemic therapy—such as chemotherapy or targeted therapy—with local therapy that eradicates both the primary tumor and metastatic lesions using radiation can extend patient survival.
This combined systemic–local treatment approach has demonstrated particular effectiveness in lung cancer with epidermal growth factor receptor (EGFR (搜索)) gene mutations. In a multinational phase III clinical trial conducted overseas, the combination of an EGFR-targeted agent with radiation therapy to the primary tumor and metastatic sites increased progression-free survival from 12.5 months to 20.2 months. Overall survival was also extended from 17.4 months to 25.5 months.
In another phase III clinical trial, patients who received thoracic radiotherapy in addition to targeted therapy saw their progression-free survival increase from 10.6 months to 17.1 months, and overall survival from 26.2 months to 34.4 months. The risk of disease progression decreased by 43%, and the risk of death fell by 38%.
Supporting Evidence from a Korean Multicenter Phase II Study
In Korea, Yonsei Cancer Hospital (搜索) confirmed the potential of combined therapy through a multicenter phase II study. In patients with oligometastatic lung cancer (搜索) harboring EGFR (搜索) mutations, concurrent treatment with the third-generation targeted therapy lazertinib and stereotactic body radiotherapy—which delivers highly focused radiation to tumor sites—resulted in a median progression-free survival of 34 months, with no cases of grade 3 or higher radiation pneumonitis, which is considered severe.
Based on these prior research findings, Yonsei Cancer Hospital (搜索) plans to use carbon ion therapy as a new local treatment option for oligometastatic lung cancer (搜索).
Addressing an Unmet Need in Vulnerable Patients
The therapy will be applied to patients who are elderly or have impaired lung function and therefore face a high burden with conventional radiation therapy. Patients with interstitial lung disease (搜索) or idiopathic pulmonary fibrosis (搜索) have been at risk of developing radiation pneumonitis—an inflammatory reaction in the lungs after radiation therapy—or of experiencing worsening underlying lung disease, which has made aggressive treatment difficult until now.
Professor Kyung Hwan Kim of the Department of Radiation Oncology said, "At the Yonsei Cancer Hospital (搜索) Carbon Ion Therapy Center, we plan to first expand the use of carbon ion therapy for patients with oligometastatic lung cancer (搜索) who have EGFR (搜索) mutations and other predictors of good systemic treatment response and long-term survival," adding, "We will continue to accumulate clinical data from treated patients to clarify the specific efficacy and role of carbon ion therapy in stage IV lung cancer."
Dr. Hye Ryeon Kim, director of the Lung Cancer Center, said, "Even among patients with stage IV lung cancer, there are those who can expect long-term survival if aggressive local therapy is combined, depending on the extent of metastasis and their overall condition," and added, "We will organically integrate surgery, chemotherapy and targeted therapy, conventional radiotherapy, and carbon ion therapy to present the optimal treatment strategy tailored to each patient."