Novel Radiotherapy Supports Precision Medicine Advances in Lung and Bone Cancers

Author(s):

Adnan F. Danish, MD, discusses current unmet needs in the treatment of patients with stage IV lung and bone cancers, the benefits SCINTIX technology can provide for these patients, and how John Theurer Cancer Center plans to use this technology to improve patient outcomes and support further radiation therapy research.

Adnan F. Danish, MD

The ability of SCINTIX radiation technology to deliver precise, multimodal therapy to metastatic disease sites in patients with advanced lung and bone cancers may steer the radiation oncology field toward increasingly individualized and multifaceted patient care, according to Adnan F. Danish, MD.

On February 2, 2023, the FDA granted clearance to SCINTIX biology-guided radiotherapy for the treatment of patients with primary or metastatic lung and bone tumors. SCINTIX is also cleared for the use of intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery for all solid tumors.¹

“This machine is the next level in how we will treat patients with radiotherapy,” Danish, a radiation oncologist at John Theurer Cancer Center (JTCC), Hackensack University Medical Center in Hackensack, New Jersey, as well as chief of the Division of Radiation Oncology at St Joseph’s Health in Paterson, New Jersey, said in an interview with OncLive^®.

In the interview, Danish discussed current unmet needs in the treatment of patients with stage IV lung and bone cancers, the benefits SCINTIX technology can provide for these patients, and how JTCC plans to use this technology to improve patient outcomes and support further radiation therapy research.

OncLive: What are the biggest barriers to using radiotherapy to treat patients with cancer?

Danish: There have been longstanding hurdles in radiotherapy. One is always knowing exactly where the tumor is. We have always known where it is in a single image. However, no tumor is stationary. We’ve added margins of error to accommodate for motion and changes in anatomy. Over time, we’ve become more savvy regarding identifying in real time where the tumors will be, so we can hopefully decrease the margin of treatment and therefore decrease the adverse effects [AEs] that could occur from stray radiation [hitting] critical structures. Until now, we’ve implanted beacons or fiducials in tumors and tracked those to see exactly where the tumors are when we deliver the radiation therapy. We’ve used modalities that help us conform the radiation treatment to the tumor.

We can now use the tumor as a beacon to guide radiation therapy. The SCINTIX technology is designed to use the tumor’s biology and location to deliver radiation therapy with tremendous accuracy. Rather than assuming that the tumor is stationary and adding a margin [of error] to accommodate for changes, anatomy, and motion, it detects that motion and those changes in anatomy and guides the radiation. Therefore, we should be able to treat with a much smaller margin [of error] and increase the therapeutic ratio.

What challenges arise when treating early- and late-stage lung and bone cancers, and how might the SCINTIX technology help overcome the technical issues that can arise in these settings?

Tumors in the lung and bone represent [approximately] 70% of annual cancer deaths from solid tumors. Oftentimes, patients who have multiple tumors in the lung and bone aren’t offered radiation therapy because it’s logistically and technically challenging to address multiple tumor locations in a single treatment session. We need to be able to localize the tumor and treat it, and each tumor requires a separate session.

This technology will allow us to treat multiple tumor locations in a single session. For patients who present with metastatic disease simultaneously involving the lungs and bones, we can now potentially address those tumors in single or multiple treatment sessions and treat multiple tumors at the same time, which allows us to offer this treatment to more patients than before.

How does the SCINTIX machine integrate IMRT, SBRT, and the treatment of metastatic lung and bone tumors?

We’ve always used IMRT. We have begun to use SBRT, a treatment modality that allows us to give higher doses of radiation in a single session. Now what we will do is add another facet to the treatment and use the biology of [patients’] tumors to guide treatment.

PET CT imaging has changed the way we diagnose and stage patients with cancer. It uses their physiologic and anatomic information to provide us with a diagnostic [profile] of how these cancers present. Now, we will combine that with therapy. In patients with lung and bone tumors that are active on a PET scan, we will be able to localize treatment to those tumors and treat with standard-of-care [SOC] procedures [such as] IMRT and SBRT.

We can now choose which modality to [use or] combine multiple modalities in 1 setting to treat multiple tumors, which we were unable to do before. This is without [using] implanted fiducials or only anatomic information. We can now use the tumor’s activity to focus the radiation. For example, lung tumors move every time a patient breathes. Now, we can accommodate for that breathing motion and focus the high-dose radiation [and] minimize the damage that can occur to surrounding structures.

How does SCINTIX determine where to deliver radiotherapy, and how does this technology differ from using CT scans or MRI before treatment?

With SCINTIX, functional imaging data from PET emissions will direct personalized radiotherapy. [This is] different from CT scans and MRI, which give us a just a moment in time where the tumor is located and what it looks like. We [use] that information, along with historic information about motion, and maybe some motion studies we’ve done before, to define how to deliver the radiation.

With SCINTIX, we will inject patients with the same radiotracer we used to diagnose their tumor. As the radiotracer is taken up by the cancer, it will deliver that information, with just a few milliseconds between emission and treatment, to guide the radiation. It uses functional data vs just anatomic data to guide how we treat patients, which is next level.

We’re all moving toward personalized cancer treatments. Not all cancers move the same or look the same, and we will take advantage of the PET technology to define that for each patient. That will hopefully help us offer more precise and better care.

Does treatment with SCINTIX open new opportunities for treating patients whose cancer has metastasized?

Absolutely. Data now suggest that in patients who present with stage IV cancer who have limited disease involving multiple sites—generally defined as less than 5 sites—delivering ablative therapy, along with SOC systemic therapy, seems to [provide] better survival [outcomes]. We have not been able to translate that to patients with disease that involves more than 5 sites, because the technology has not been able to handle that [disease] presentation.

With [SCINTIX], wherever the PET lights up, we should be able to treat. We’re hoping to open that idea to patients who present with more than 5 disease sites [or] polymetastatic disease.

We’re investigating ways to combine radiation therapy with other targeted therapies [such as] immunotherapy, therapies targeted toward specific receptors, and SOC chemotherapy. [When] we add ablative therapy, [we will] hopefully improve patient outcomes. All the data suggest that will be the case, but we’ve been limited by the technologies we currently have.

How do you plan to use SCINTIX in your clinic at JTCC?

We want to develop an entire program centered around patients who present with stage IV cancer, that has traveled outside their primary tumor to other sites in their body. [Determining] how to effectively give these patients the best chance at long-term, meaningful survival has always been a challenge.

My plan for this technology is to [use] it to develop a program that will hopefully address [the unmet needs of] patients who present with that stage of disease and combine [SCINTIX] with either a SOC treatment or clinical trials that are investigating therapies. These patients are traditionally not seen by radiation oncologists because their disease cannot be addressed by the current technology, meaning [they have] more than 10 or 20 sites [of disease]. That’s our purpose here.

I’m [also] looking at ways to combine radiotherapy with immunotherapy. Data suggest that radiation therapy can synergize with immunotherapy. That’s where radiation therapy is going. How can we provide consolidation and salvage [therapies] as well as synergize with patient’s immune systems to hopefully offer a chance at complete response?

JTCC is 1 of 7 early adopters [of SCINTIX] in the United States. We’re paving the way for this technology and treatment modality. JTCC has always led the way for oncology care with SOCs and innovations. This is in line with that mission.

What does the future look like for this technology?

The FDA has approved [SCINTIX for] lung and bone cancer indications, [and it is] now moving toward approval for other disease sites. That may come soon, as we do studies to show the [technology’s] validity.

[Additionally, beyond] the standard radiotracer used for PET scans, [we’re investigating] other tumor-specific radiotracers. For example, the pylarify scan is specific to prostate cancer, and there are other tumor-specific radiotracers we use for diagnostic PET scans that RefleXion Medical Inc will validate on their SCINTIX machine. As we do that, we’ll have more precise treatments specific to patients’ tumor types.

SCINTIX will not be 1 size fits all. This is where cancer therapy is moving. Instead of using the same therapy for all patients, we will look specifically at the kind of tumor that they have, the tracer that is active, and how we can combine that activity to guide the radiation and synergize it with specific therapies, including immunotherapy, and hopefully offer each patient the best chance.

What is your main message for colleagues regarding SCINTIX?

It’s something to watch for. In oncology, we all look for innovation and creative ways to make our patients’ outcomes better [and] minimize the AEs of the therapies. SCINTIX will help us achieve that in a way we have been considering for years. [We will use] patient and cancer physiology to guide precision medicine. That’s what we’ve been waiting for and what we’re moving toward.

Editor’s Note: Some questions in this interview were developed in collaboration with John Theurer Cancer Center.