Last year in the UK over 60,000 cancer patients enrolled on clinical trials aimed at improving cancer treatments and making them available to all.
A trial looking at stereotactic ablative radiotherapy for non small cell lung cancer (SARON)
This trial is for people with non small cell lung cancer (NSCLC) that has spread (advanced cancer). The cancer must not have spread to more than 5 areas in the body and in no more than 3 organs.
Cancer Research UK supports this trial.
More about this trial
Non small cell lung cancer can sometimes spread to other parts of the body. This is called advanced non small cell lung cancer (NSCLC).
Doctors can treat advanced NSCLC with chemotherapy, immunotherapy or a combination of both. You may hear doctors call this type of treatment as systemic anti cancer therapy (SACT). This is the standard of care treatment.
Common chemotherapy drugs include:
A common immunotherapy drug is pembrolizumab.
Doctors are looking for ways to improve treatment for people with advanced NSCLC. In this trial, they are looking at radiotherapy and SACT. They think it can help kill the cancer and reduce the risk of it coming back.
Doctors can give radiotherapy in 3 different ways
- stereotactic ablative radiotherapy (SABR or SBRT)
- stereotactic radiosurgery (SRS)
- conventional (standard) radiotherapy
SABR and SRS gives radiotherapy to the cancer from different positions around the body or head. Doctors can direct a high dose of treatment to the cancer. And small doses to the healthy tissues and organs that surround the cancer.
Sometimes you can’t have SABR. This might be because of the size or location of the cancer in your lungs. In this situation the doctors will use conventional radiotherapy to treat the cancer in your lungs.
In this trial you have:
- SABR or conventional radiotherapy to the primary cancer in your lungs
- SABR to treat the areas in your body where the cancer has spread
- SRS to treat any cancer spread to the brain (metastases)
Everyone taking part in this trial has 1 of the following:
- SACT and radiotherapy
The main aims of this trial are to:
- find out how well SACT and radiotherapy work as a treatment
- learn more about the side effects
Who can enter
The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you.
You may be able to join this trial if all of the following apply:
- You have non small cell lung cancer (NSCLC)
- Your cancer has spread to no more than 5 areas in your body, and in no more than 3 organs
- Your cancer can be treated with radiotherapy
- You have between 1 to 5 areas of cancer outside your lungs that can be seen and measured on a scan (stage 4 lung cancer)
- You have had a recent
PET CT scanof your body and MRI scan of your head
- You are well enough to have treatment with SACT and radiotherapy
- Your lungs are working well enough to have treatment
- You are well enough to carry out your normal activities, apart from heavy physical work (performance status of 0 or 1)
- You are willing to use reliable contraception during treatment and for 6 months afterwards if there is any possibility you or your partner could become pregnant
You have a scan after 2 SACT treatments. Continuing in the trial will depend on these results. You will be able to continue in the trial as long as you still meet all the above and:
- Your cancer stayed the same or got better after 2 SACT treatments
- You are well enough to be up and about for at least half the day (performance status 0, 1 or 2)
You cannot join this trial if any of these apply:
- You have previously had treatment for NSCLC
- You have had radiotherapy to help with symptoms, or you are due to have it after starting in this trial
- You have certain lung conditions such as thickening of the lung tissue (fibrosis) or a connective tissue disease (such as Lupus)
- You have had surgery or radio frequency ablation (RFA) to 1 or more areas of your cancer that has spread
- You are taking a type of drug called
- Your cancer has only spread to your brain or you have more than 4 areas of cancer in your brain
- Your cancer has spread to the area where the brain meets the spinal cord (the brain stem) or the membranes surrounding the brain (leptomeningeal disease)
- Your cancer has spread, or is at high risk of spreading, into large veins or arteries, your food pipe, stomach, bowel, skin or the windpipe
- Your cancer has spread to both glands on top of the kidneys (
- You have had another cancer, apart from cancers that have been successfully treated more than a year ago, non melanoma skin cancer or an early cervical cancer
- You have fluid between the sheets of tissue that cover the outside of the lung (pleural effusion) or the heart (pericardial effusion)
- You are pregnant or breastfeeding
This is a phase 3 trial. The researchers need about 340 people from the UK to take part.
Your doctor will explain which SACT treatment will be best for you. It can be:
- a platinum chemotherapy (cisplatin or carboplatin) and 1 other chemotherapy drug (chemotherapy alone)
- combination of chemotherapy and immunotherapy
- immunotherapy alone
After 2 treatment cycles you have a scan. Your doctor looks at the results of the scan. Continuing in the trial depends on these results:
- if your cancer has grown or spread to new areas, you stop the trial
- if your cancer has stayed the same or shrunk, you continue on the trial
If you continue, the next part of the trial is randomised. The people taking part are put into 1 of the following treatment groups by computer:
- SACT and radiotherapy
Neither you nor your doctor can choose which group you are in.
You have another 2 treatment cycles of SACT. You may be able to continue having the same treatment if it is helping you and the side effects aren’t too bad.
SACT and radiotherapy
You have another 2 cycles of SACT. Within 2 to 6 weeks of finishing, you start radiotherapy.
You have SABR or conventional radiotherapy to the areas of cancer inside your lungs. It can take up to 21 days to have SABR and 6 ½ weeks to have conventional radiotherapy.
If you have conventional radiotherapy, you have it every day, Monday to Friday, with a break at weekends. Each treatment takes about 15 to 20 minutes.
You might need to travel to another hospital to have your SABR treatment. You have treatment with SABR every day, Monday to Friday. Or on alternate days. You always have a break at weekends.
If you have treatment with SABR to the areas of cancer inside your lungs, you might need to have small metal markers (fiducial markers) put in before the start of treatment. This is the size of a grain of rice. Doctors use this to track the cancer and direct the radiotherapy to it.
You have SABR or SRS to the areas of cancer outside the lungs. This can take between 5 to 21 days depending on the area of your body having radiotherapy.
Quality of life
Everybody taking part on this trial will be asked to complete a quality of life questionnaire:
- before starting SACT treatment
- at set times after you finish treatment
It will ask about how you have been feeling and what side affects you have had.
You see a doctor and have some tests before taking part. These tests may include:
- a PET CT scan
- a CT scan if needed
- an MRI scan or a CT scan of the brain
- a physical examination
- lung tests (such as spirometry)
- blood tests
- urine test
You see the doctor for blood tests and a physical examination before each treatment cycle. And then:
- you have weekly check ups during your course of SABR or SABR and conventional radiotherapy
- if you are having conventional radiotherapy for your primary lung cancer you have check ups every 2 weeks during the course of your treatment
When you finish 4 cycles of SACT, you see the trial doctor after 1 month and then:
- every month for the first 3 months
- every 3 months after
After 2 years, you see the trial doctor every 6 months.
If you have SABR to the lungs, you might have 2 extra visits after:
- 2 weeks
- 3 months
You have a CT scan 3 months after finishing treatment. Then at set times, until 3 years after the end of your treatment.
The hospital trial team monitor you during the time you have treatment and you will be given a phone number to call them if you are worried about anything. The team will tell you about all the possible side effects before you start the trial.
The side effects you have depend on the area of your body having radiotherapy. You doctor can tell more about this.
The most common side effects of radiotherapy to the lungs are:
- chest pain
- difficulty swallowing
- tiredness (fatigue)
- loss of appetite
- drop in the number of red blood cells (anaemia) and white blood cells (causing you to feel tired, breathless and have an increased risk of infections)
- skin changes (such as redness and itchiness)
- lung inflammation
We have more information about radiotherapy for lung cancer.
We also have information about the possible side effects of cancer drugs on our cancer drugs A-Z list.
How to join a clinical trial
Dr Fiona McDonald
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
National Cancer Research Institute (NCRI)
University College London (UCL)
This is Cancer Research UK trial number CRUK/14/027.