The BMJ Awards 2017: UK Research PaperBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1822 (Published 11 April 2017) Cite this as: BMJ 2017;357:j1822
- Nigel Hawkes, freelance journalist
- London, UK
Dexamethasone for non-small cell lung cancer
Lung cancer commonly spreads to the brain and the prognosis is very poor, with survival measured in weeks. For the past 40 years whole brain radiotherapy has been used for this group of patients without a lot of evidence that it does any good. Organising a randomised trial to find out was very challenging, says Ruth Langley, professor of oncology and clinical trials at the Medical Research Centre Clinical Trials Unit at University College London.
“Asking patients and doctors to take part in a trial that involves omitting a therapy is difficult when things are quite bleak,” she says. “So it’s a real tribute to those involved that they managed to get so many into the trial.” In total, 538 patients were recruited from 69 centres in the UK and three in Australia.
Unusually, the trial management group asked the steering committee three years after starting the trial if interim data from the first 151 patients could be released. “This was a brave decision,” she says. “Normally if you’re doing a big trial you do a smaller trial first to see if there’s a hint of an effect. We didn’t have any data like that. This interim data showed that omitting radiotherapy wasn’t having a bad effect on outcomes, and helped to complete recruitment.”
The results showed that adding whole brain radiotherapy to optimal supportive care and the drug dexamethasone did not significantly improve survival or quality of life. “Omitting radiotherapy, which takes five days, avoids additional hospital visits, treatment related side effects, and allows more time for families to be together,” Langley says. She expects the result to change clinical practice for this group of patients. …