Veterans lung cancer treatment study is largest ever

VALOR trial aims to discover the optimal treatment for stage 1 lung cancer

A clinical trial comparing treatments for stage 1 lung cancer, the largest lung cancer treatment study ever, has enrolled its 200th participant.

The Veterans Affairs Lung Cancer Surgery or Stereotactic Radiotherapy (VALOR) trial aims to discover whether traditional lung-resection surgery or Stereotactic Body Radiation Therapy (SBRT) is best for treating stage 1 non-small cell lung cancer.

“This may be one of the most difficult and most important clinical trials in lung cancer,” says study co-chair Drew Moghanaki, MD, MPH, chief of thoracic oncology in the radiation oncology department at UCLA Health. “We feel that the data from this study will inform practice for many decades to come as new treatments continue to be discovered that can be combined with either surgery or radiation.”

The difference between the two

Surgery has long been standard care for the treatment of lung cancer, but SBRT has also shown promising results, says Dr. Moghanaki, who also directs care and research for patients with lung cancer at the Greater Los Angeles Veterans Affairs Medical Center.

“These treatments are very similar. They just have different journeys,” he says.

Both procedures take three to five days to complete, whether a patient comes into the hospital for surgery or radiation treatment.

'I’m optimistic that, regardless of the results of the study, we will have findings that expand options for patients.'

Dr. drew moghanaki, chief of thoracic oncology at UCla health

Because surgical treatment samples lymph nodes, it can reveal whether the cancer has spread, Dr. Moghanaki says. With SBRT, the diagnosis of spread to the lymph nodes would be identified through follow-up scans.

“It’s unclear whether knowing earlier can make a difference,” he says.

The VALOR study, which is recruiting 670 veterans with lung cancer, is the first to compare surgery and SBRT survival outcomes, pulmonary function and patient quality of life. Participants are randomly assigned to receive either surgery or radiation treatment and will be followed for a minimum of five years after treatment.

People with a stage 1 lung cancer diagnosis who aren’t participating in the trial could choose between surgery or SBRT.

Sponsored by the VA Cooperative Studies Program, the study opened at six sites in 2017 and has expanded to 21 sites to date.

Dr. Moghanaki credits the recruitment success to “helping people understand the value of enrolling in a clinical research study” and the altruism of veterans.

“Our veterans have been amazing in their desire and willingness to participate in a trial that will help another veteran,” he says.

Quest to cure lung cancer

Dr. Moghanaki hypothesizes there will be little, if any, measurable difference between the two treatment methods when it comes to overall survival for people with early-stage lung cancer.

“One of the most promising things is, if this study shows that patients who opt for SBRT do just as well as those who choose surgery, that opens up even more opportunities for research and discovery,” he says. “This helps the field move forward.”

He and study co-chair David H. Harpole Jr., MD, of Duke University are inspired by emerging treatments for lung cancer, including immunotherapy and new ablation techniques that can be administered percutaneously (through the skin) or endobronchially (through the throat) with robotic bronchoscopy machines, and eager to see how they might work alongside surgery or SBRT.

“Our quest to cure and eradicate lung cancer forever will require local and systemic therapy,” Dr. Moghanaki says. “I’m optimistic that, regardless of the results of the study, we will have findings that expand options for patients.”

The study is expected to continue through 2027.

If you’re a veteran and would like to learn more, visit the VALOR clinical trial site.