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2019 Thoracic Cancers Symposium: Local Consolidative Therapy and Overall Survival in Oligometastatic NSCLC

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Key Points

  • At a median follow-up of 52 months, the median overall survival was 29 months for patients who received local consolidative therapy to all sites, compared to 23 months for patients who did not.
  • The rate of locoregional progression was 21% for patients who received local consolidative therapy to the primary tumor, compared to 43% for patients who did not.
  • Local consolidative therapy to the primary tumor also trended toward an association with improved overall survival, although this was not the case with local consolidative therapy to distant metastases.

A new analysis of patients treated with local consolidative therapy for oligometastatic non–small cell lung cancer (NSCLC) found that the intensive treatment approach is associated with improved overall survival. Local consolidative therapy—consisting of radiation therapy or surgery—extended median survival by 6 months for patients diagnosed with three or fewer metastases outside of the lungs. These findings were presented in a presscast ahead of the 2019 Multidisciplinary Thoracic Cancers Symposium (Abstract 1).

“Though not all people with stage IV NSCLC are the same, there are treatment options for those with limited metastatic disease,” said Erin Corsini, MD, presenting author of the study and a clinical research fellow at The University of Texas MD Anderson Cancer Center. “Specifically, in select populations of patients with oligometastatic NSCLC, local consolidative therapy to all sites of disease with surgery, radiation therapy, or a combination of the two appears to show promise in prolonging overall survival. The patients who seem to gain the most benefit are those with more favorable disease characteristics, such as adenocarcinoma, early intrathoracic stage, and absence of bone metastases.”

Study Methods

For the study, researchers analyzed records of 194 patients treated for stage IV NSCLC at MD Anderson between 2000 and 2017. The median age was 62, and the study population was 57% male. Eligible patients included those diagnosed with one to three synchronous metastatic tumors, with intrathoracic nodal disease counted as one site; most patients (70%) had two to three distant metastases. The brain was the most common metastatic site (44% of patients). Nearly all patients (90%) received systemic therapy in addition to local consolidative therapy.

Results

Comprehensive local consolidative therapy to all disease sites (ie, the primary tumor and all distant metastases) was associated with improved overall survival. At a median follow-up of 52 months, the median overall survival was 29 months for patients who received local consolidative therapy to all sites, compared to 23 months for patients who did not (P = .03). The relationship held on multivariable analysis controlling for patient and disease characteristics (P = .03).

Local consolidative therapy to the primary tumor was associated with improved control of local and regional recurrences. The rate of locoregional progression was 21% for patients who received local consolidative therapy to the primary tumor, compared to 43% for patients who did not (P < .01). Local consolidative therapy to the primary tumor also trended toward an association with improved overall survival (P = .08), although this was not the case with local consolidative therapy to distant metastases (P = .21).

“Several recent clinical trials have shown that local consolidative therapy could provide a tangible survival benefit, and our results from evaluating a relatively large group of patients are not only consistent with, but arguably bolster, the previously reported findings,” said Dr. Corsini. “Taken together, these studies make a strong case for local consolidative therapy in patients with oligometastatic NSCLC.” 

“As the evidence accumulates and we learn that there are options for patients with oligometastatic disease, it is important that providers, patients, and families discuss these possibilities and how they align with their goals and priorities for treatment,” she concluded.

Disclosure: The study presenter’s full disclosures can be found at thoracicsymposium.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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