Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

Lang, Pencilla; Gomez, Daniel R.; Palma, David A.

doi:10.1055/s-0039-3400290

Cited by 4 publications

(2 citation statements)

References 54 publications

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“…Several RCTs on the role of SABR in oligometastatic disease are ongoing, with different inclusion criteria and systemic treatments [ 28 ]. Some allow treatment with ICI, but are often not aimed at evaluating ICI with LAT specifically.…”

Section: Prospective Evidence In the Era Of Icimentioning

confidence: 99%

Radiation for Oligometastatic Lung Cancer in the Era of Immunotherapy: What Do We (Need to) Know?

Peeters

Limbergen

Hendriks

et al. 2021

Cancers

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Oligometastatic cancer is recognized as a separate entity within the spectrum of metastatic disease. It was suggested that patients with oligometastatic disease can obtain long-term survival by giving local ablative therapy (LAT) to all visible disease locations. However, the true extent from which metastatic cancer should be called “oligometastatic” is unknown, although a consensus definition for oligometastatic disease is proposed by research organizations, such as the EORTC (maximum of five metastases in three organs). Different states of the oligometastatic disease are defined, such as synchronous vs. metachronous, oligopersistent vs. oligoprogressive disease. All clinical trials including patients with non-small cell lung cancer (NSCLC) are small and most are not randomized. Two small randomized phase II trials on synchronous disease showed an improvement in progression free survival, with the addition of LAT, and one also demonstrated an overall survival benefit. Immune checkpoint inhibitors (ICI) were not part of the treatment in these trials, while ICI significantly improved long-term outcomes of patients with metastatic NSCLC. Radiotherapy might improve the prognosis of patients treated with ICI because of its immunostimulatory effects and the possibility to eradicate metastatic deposits. Here, we summarize the data for adding ablative radiotherapy to the treatment of oligometastatic NSCLC, especially in the ICI era, and discuss the challenges of combined treatment.

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Section: Prospective Evidence In the Era Of Icimentioning

confidence: 99%

Radiation for Oligometastatic Lung Cancer in the Era of Immunotherapy: What Do We (Need to) Know?

Peeters

Limbergen

Hendriks

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Metastatic cancer has long been considered an incurable disease ( 1 ). However, in 1995, Hellman and Weichselbaum first proposed the oligometastatic disease (OMD) concept, suggesting that biologically limited small number of bundles or slowly progressing metastatic cancers could be curable ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Mathematical prediction with pretreatment growth rate of metastatic cancer on outcomes: implications for the characterization of oligometastatic disease

et al. 2023

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BackgroundOligometastatic disease (OMD) represents an indolent cancer status characterized by slow tumor growth and limited metastatic potential. The use of local therapy in the management of the condition continues to rise. This study aimed to investigate the advantage of pretreatment tumor growth rate in addition to baseline disease burden in characterizing OMDs, generally defined by the presence of ≤ 5 metastatic lesions.MethodsThe study included patients with metastatic melanoma treated with pembrolizumab. Gross tumor volume of all metastases was contoured on imaging before (TP-1) and at the initiation of pembrolizumab (TP0). Pretreatment tumor growth rate was calculated by an exponential ordinary differential equation model using the sum of tumor volumes at TP-1 and TP0 and the time interval between TP-1. and TP0. Patients were divided into interquartile groups based on pretreatment growth rate. Overall survival, progression-free survival, and subsequent progression-free survival were the study outcomes.ResultsAt baseline, median cumulative volume and number of metastases were 28.4 cc (range, 0.4-1194.8 cc) and 7 (range, 1-73), respectively. The median interval between TP-1 and TP0 was -90 days and pretreatment tumor growth rate (×10-2 days-1) was median 4.71 (range -0.62 to 44.1). The slow-paced group (pretreatment tumor growth rate ≤ 7.6 ×10-2 days-1, the upper quartile) had a significantly higher overall survival rate, progression-free survival, and subsequent progression-free survival compared to those of the fast-paced group (pretreatment tumor growth rate > 7.6 ×10-2 days-1). Notably, these differences were prominent in the subgroup with >5 metastases.ConclusionPretreatment tumor growth rate is a novel prognostic metric associated with overall survival, progression-free survival, and subsequent progression-free survival among metastatic melanoma patients, especially patients with >5 metastases. Future prospective studies should validate the advantage of disease growth rate plus disease burden in better defining OMDs.

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The role of surgery in the treatment of oligoprogression after systemic treatment for advanced non-small cell lung cancer

et al. 2021

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Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

Cited by 4 publications

References 54 publications

Radiation for Oligometastatic Lung Cancer in the Era of Immunotherapy: What Do We (Need to) Know?

Radiation for Oligometastatic Lung Cancer in the Era of Immunotherapy: What Do We (Need to) Know?

Mathematical prediction with pretreatment growth rate of metastatic cancer on outcomes: implications for the characterization of oligometastatic disease

The role of surgery in the treatment of oligoprogression after systemic treatment for advanced non-small cell lung cancer

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