Dr Luo on Optimal Initial Chemotherapy Regimens in NUT Carcinoma

Jia Luo, MD, medical oncologist, Lowe Center for Thoracic Oncology, cancer researcher, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, discusses a retrospective analysis of initial chemotherapy regimens for the treatment of patients with locally advanced and metastatic NUT carcinoma, which was presented at the 2023 IASLC World Conference on Lung Cancer.

Prior research has determined that select patients with NUT carcinoma are sensitive to chemotherapy. Although limited case reports suggest that platinum- and ifosfamide-based regimens are the most effective treatment options, the chemotherapy most optimal for this subset is not definitively known. Therefore, a retrospective study was conducted to assess which initial chemotherapy regimen was associated with superior survival outcomes.

In the study that was conducted, investigators analyzed primary medical records from 118 patients with non-metastatic or metastatic NUT carcinoma who received chemotherapy treatment and consented to participate in a worldwide registry.

Findings revealed that patients with non-metastatic disease experienced a progression-free survival (PFS) benefit with ifosfamide-based treatment vs a platinum-based regimen, Luo reports, noting that this approach enhanced the depth of responses. However, these positive signals did not extend to overall survival, and were not seen in the metastatic cohort, Luo notes. Consequently, the study's primary recommendation is that ifosfamide-based treatment should not become standard practice for individuals with NUT carcinoma, Luo states.

The second part of the study focused on those who achieved long-term responses, Luo explains. All of these patients had non-metastatic disease and received multimodal therapy, which included surgical resection and often involved radiation therapy, Luo details. This emphasizes the importance of comprehensive and personalized approaches in managing patients with NUT carcinoma, particularly in cases where the disease is resectable at diagnosis, Luo emphasizes.

Overall, these findings underscore the critical need for more effective combination therapies in this population, Luo says. Clinical trials at institutions such as Dana-Farber Cancer Institute are actively addressing this challenge, she adds. The study authors encourage both healthcare providers and patients to consider participating in clinical trials in this disease space, Luo concludes.