Local consolidative therapy improves oligometastatic NSCLC survival
medwireNews: Patients with stage IV non-small-cell lung cancer (NSCLC) and no more than three metastases derive an overall survival (OS) benefit from aggressive local consolidative therapy (LCT), suggest trial results.
Researcher Daniel Gomez (The University of Texas MD Anderson Cancer Center, Houston, USA) and collaborators note that “[t]he trial was closed early after it demonstrated an observed 8-month benefit in PFS [progression-free survival] for patients who received LCT relative to patients who received maintenance therapy or observation.”
And the current analysis shows that the PFS benefit is maintained over a longer follow-up, and OS is also significantly improved with LCT versus maintenance therapy or observation, they say in the Journal of Clinical Oncology.
Specifically, during a median follow-up of 38.8 months, PFS was a median of 14.2 months for the 25 participants who were randomly assigned to receive LCT with radiation or surgery after remaining progression-free for at least 3 months after first-line systemic therapy. This was significantly longer than the median of 4.4 months achieved by their 24 counterparts who received standard maintenance or observation.
Median OS was similarly significantly prolonged in the LCT than control group, at 41.2 and 17.0 months, respectively. And patients in the LCT study arm had significantly longer survival after progression, at a median of 37.6 months versus 9.4 months in the maintenance or observation arm.
“These results build on our prior report by demonstrating that benefits of LCT extend beyond delay of initial progression,” the authors remark.
And they point out that the “OS benefit in the group originally assigned to receive LCT was observed despite allowance for patients to cross over from the [maintenance therapy/observation] arm to the LCT arm at the time of progression.”
Gomez and colleagues note several limitations to their research, such as the fact that early closure resulted in a smaller than planned sample size, “which substantially limits subgroup analyses.”
Furthermore, “because our trial opened in 2012, it did not include immunotherapy, which has revolutionized the treatment of both locally advanced and metastatic NSCLC during the past 5 years,” they write.
In conclusion, the team emphasizes the need for future studies “to definitively assess the role of LCT in larger populations (eg, phase III trials such as NRG-LU002) and in the context of novel systemic therapies.”
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