Efaproxiral: should we hold our breath?

Suh et al breathe a bit of new life into two long-standing endeavors with their report in this issue of a phase III study of whole-brain radiotherapy (WBRT) and efaproxiral (RSR13), a hemoglobin modifier meant to increase tissue oxygenation. For decades, radiation oncologists have sought to enhance tumor control and patient survival by addressing the problem of hypoxia and, separately, to improve results of WBRT by sensitization, dose escalation, or altered fractionation. In this large randomized trial, efaproxiral added to WBRT and oxygen breathing increased median survival time from 4.4 to 5.4 months (P .16) and the overall response rate from 38% to 46% (P .10). Larger gains were seen in the combined non–small-cell lung cancer (NSCLC) and breast cancer subset, for whom the median survival time improved from 4.4 to 6.0 months (P .07) and overall response rate improved from 41% to 54% (P .01).