Retrospective or single-arm prospective studies have shown that local consolidative therapy (LCT) can extend progression-free survival (PFS) in patients with oligometastatic disease. An overall survival (OS) benefit in patients with non-small-cell lung cancer (NSCLC) has now been demonstrated in a prospective randomized phase II trial.
Patients with advanced-stage NSCLC and ≤3 metastatic lesions without progression ≥3 months after front-line systemic therapy received standard maintenance therapy or observation with (n = 25) or without (n = 24) LCT (with surgery and/or radiotherapy).
At a median of 38.8 months, LCT was associated with an OS benefit: median 41.2 months versus 17.0 months (P = 0.017). Previously published results of this trial indicated a statistically significant PFS benefit with LCT that has now been confirmed: 14.2 months versus 4.4 months (P = 0.022).
OS durations after disease progression were longer in the LCT arm than in the control arm: median 37.6 months versus 9.4 months (P = 0.034). Salvage therapy for these patients involved additional systemic agents and/or LCT to all progressing sites. Patients who received LCT-based salvage therapy (41%) had longer OS durations than those who received other salvage therapies: median not reached (NR; 95% CI 11.5 months–NR) versus 16.4 months (95% CI 8.7–40.9 months; P = 0.01). The previously reported incidence of grade ≥3 toxicities was 20% in the LCT arm versus 8% in the control arm; no additional events were described.
Together with the recently published results of the SABR-COMET trial, this study contributes to the growing evidence of a curative role of local ablative therapies in patients with oligometastatic cancer.
References
Original article
Gomez, D. R. et al. Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non–small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J. Clin. Oncol. https://doi.org/10.1200/JCO.19.00201 (2019)
Further reading
Gomez, D. R. et al. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non–small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. 17, 1672–1682 (2016)
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Romero, D. Benefit from LCT in oligometastatic NSCLC. Nat Rev Clin Oncol 16, 466 (2019). https://doi.org/10.1038/s41571-019-0233-1
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DOI: https://doi.org/10.1038/s41571-019-0233-1