Clinical trials that show positive patient response to systemic therapies for cancer should not necessarily lead to reduction in the use of local therapies such as radiation and surgery.
In an editorial published online by the Journal of Clinical Oncology, Lawrence Marks, MD, chair of UNC’s department of radiation oncology and a UNC Lineberger member, and Leonard Prosnitz of the Duke University Medical Center, write that patients who respond positively in clinical trials to novel chemotherapy agents and other system-wide therapies may also benefit the most from local surgery and radiation therapy.
In clinical practice, physicians operating outside of clinical trials should continue to employ local radiation therapy. While advances in treatment and further study may reveal evidence that encourages less reliance on local therapies, it will take time and extensive study to reveal the wisdom of that approach.
“We might be outsmarting ourselves by continually trying to identify subgroups of patients and individualizing therapy accordingly. Personalized medicine is certainly the current rage, and the attraction of such an approach is self-evident. However, we may be overestimating our knowledge of the underlying biologic realities and excessively relying on imprecise imaging and pathologic assessments,” according to the authors.