Combining local and systemic therapy improves survival for advanced NSCLC
medwireNews: In patients with stage IV non-small-cell lung cancer (NSCLC), the addition of surgical resection or external beam radiotherapy (EBRT)/thermal ablation (TA) to systemic therapy increases overall survival (OS) versus systemic therapy alone, suggests a comparative effectiveness study.
“[T]his study demonstrates that the addition of a local treatment option for the primary tumor site combined with systemic therapy [is] associated with overall survival, even after accounting for potential confounders,” write Hyun Kim (Yale School of Medicine, New Haven, Connecticut, USA) and co-researchers in JAMA Network Open.
Using information from the US National Cancer Database, the team looked at the survival of 34,887 adults with stage IV NSCLC, of whom 835 underwent surgical resection plus systemic therapy, 9539 underwent EBRT/TA plus systemic therapy, and 24,513 received systemic therapy alone.
At a median follow-up of 39.4 months, OS was longest among patients treated with surgical resection plus systemic therapy, with a significant advantage over both EBRT/TA plus systemic therapy and systemic therapy alone, with hazard ratios (HRs) for death of 0.62 and 0.59, respectively, after adjusting for potential confounders, including preferential surgical resection in patients with oligometastatic NSCLC.
And the combination of EBRT/TA plus systemic therapy was also associated with significantly better OS than systemic therapy alone (HR=0.95).
Further investigation identified an “[o]ptimal EBRT/TA group” comprising patients with oligometastatic, T1–T2, N0–N1 squamous cell carcinoma. In this population, the combination of EBRT/TA plus systemic treatment had “a clinically relevant” OS benefit over systemic therapy alone, say the researchers, with an HR of 0.68, and OS rates at 1, 2, and 3 years of 60.4% versus 45.4%, 32.6% versus 19.2%, and 20.2% versus 10.6%, respectively.
By contrast, patients with T3–T4 and N2–N3 adenocarcinoma and at least two distant metastatic sites had significantly worse OS with the addition of EBRT/TA to systemic therapy (HR=1.39).
Kim et al conclude: “The present study supports a combined approach of local therapy in addition to systemic treatment for select patients with oligometastatic NSCLC.
“Prospective research should focus on combination treatment for this subgroup, including the benefits of TA, in patients with oligometastatic disease who cannot tolerate surgical resection or receive EBRT.”
By Catherine Booth
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