The investigators postulated that the exploitation of the pro-immunogenic effects of radiotherapy with thymosin might result in abscopal responses among patients with metastatic cancer. The research is designed to evaluate the efficacy and toxicity of patients treated with hypofractionated radiotherapy combined with thymosin alpha 1. An exploratory biomarker analysis in blood and tumor samples is also planned.
Name: TKI
Description: Gefitinib 250mg po qd or Erlotinib 150mg po qd or Icotinib 125mg po tidType: Drug1
Name: Thoracic Hypofractionated Radiotherapy
Description: 40-45 Gy/5-15fType: Radiation1
Name: Thymosin Alpha 1
Description: Initiating thymosin alpha 1 therapy(1.6mg, qd, d1-d14;1.6mg, biw, d15-d90) at the second week of radiotherapy.Type: Drug1
Description: To assess the proportion of patients with an abscopal response (defined as at least a 30% decrease in the longest diameter of the best responding abscopal lesion) at 1-6 months after the radiation therapy
Measure: The proportion of patients with an abscopal response assessed at 1-6 months after the radiation therapy Time: 1-6 monthsDescription: FACT-E score at the 4 months after docetaxel consolidation therapy
Measure: To assess the short-term quality of life (QOL) Time: 4 monthsDescription: The investigators will assess the rate of symptomatic radiation pneumonitis in patients who received the radiation therapy
Measure: Rate of CTCAE grade 2 or higher radiation pneumonitis Time: 1 yearsSingle Group Assignment
There is one SNP
Inclusion Criteria: - Newly diagnosed metastatic lung adenocarcinoma harboring sensitizing EGFR mutations (L858R, exon 19 deletion), and showed stable disease after 3 months TKI, evaluated twice by PET/CT scan, brain MRI, and abdomen ultrasound (≥3 measurable lesions, and these lesions haven't received local therapy) - Age 18 years or older - ECOG Performance Status 0-2 - Adequate bone marrow, liver and renal function, as specified below: Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L; Hemoglobin ≥ 8 g/dL; Platelets ≥ 100 x 109/L; Serum total bilirubin ≤ 1.5 x upper limit of normal (ULN) ; AST and ALT ≤ 2.5 x ULN or ≤ 5 x ULN if liver metastases are present; Serum creatinine ≤ 1.5 x upper limit of normal or creatinine clearance ≥ 60ml/min for patients with creatinine levels above institutional normal - For women of child-bearing potential, negative pregnancy test within 14 days prior to starting treatment - Men and women of childbearing age must be willing to use effective contraception while on treatment and for at least 3 months thereafter - Patients and their family signed the informed consents Exclusion Criteria: - Received chemotherapy before TKI therapy - Brain parenchyma or leptomeningeal disease - Concurrent malignancies other than non-melanoma skin cancer that require active ongoing treatment - Any medical co-morbidities that would preclude radiation therapy. --- L858R ---