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Long-Term Results With Local Consolidative Therapy vs Maintenance Therapy or Observation in Oligometastatic NSCLC

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Key Points

  • Local consolidative therapy was associated with improved progression-free and overall survival vs maintenance therapy or observation.
  • Overall survival was prolonged in patients receiving local consolidative therapy after disease progression on maintenance therapy or observation.

In long-term follow-up of a phase II study reported in the Journal of Clinical Oncology, Gomez et al confirmed superior outcomes with local consolidative therapy vs maintenance therapy or observation in patients with oligometastatic non–small cell lung cancer (NSCLC).

In the open-label, multicenter study, patients with stage IV NSCLC with ≤ 3 metastases and no disease progression at ≥ 3 months after front-line systemic therapy were randomly assigned (1:1) to maintenance therapy or observation, or to local consolidative therapy with radiotherapy or surgery to all active disease sites. The data safety and monitoring board recommended early trial closure after 49 patients were randomly assigned (25 to local consolidative therapy and 24 to maintenance therapy or observation) due to a significant progression-free survival benefit in the local consolidative therapy group.

Long-Term Follow-up

With an updated median follow-up of 38.8 months (range = 28.3–61.4 months), the progression-free survival benefit was maintained in the local consolidative therapy group (median = 14.2 months with local consolidative therapy vs 4.4 months with maintenance therapy or observation, P = .022). Median overall survival was 41.2 months with local consolidative therapy vs 17.0 months with maintenance therapy or observation (P = .017).

Postprogression survival was also prolonged in the local consolidative therapy group (median = 37.6 months vs 9.4 months, P = .034). Among 9 patients who had disease progression in the maintenance therapy or observation group and received local consolidative therapy to all lesions after progression, the median overall survival was 17 months.  

The investigators concluded, “In patients with oligometastatic NSCLC that did not progress after front-line systemic therapy, local consolidative therapy prolonged [progression-free survival] and [overall survival] relative to maintenance therapy or observation.”

Daniel R. Gomez, MD, of the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the MD Anderson Lung Cancer Priority Fund, MD Anderson Cancer Center Moon Shot Initiative, The Mohaymen Sahebzadah Family Philanthropic Grant, and National Cancer Institute. For full disclosures of the study authors, visit jco.ascopubs.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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