MA25.02 Searching for a Definition of Synchronous Oligometastatic (sOMD)-NSCLC: A Consensus from Thoracic Oncology Experts

Dingemans, A.; Hendriks, L.; Berghmans, Thierry; Lévy, Antonin; Hasan, Baktiar; Faivre-Finn, Corinne; Levra, Matteo Giaj; Giaj-Levra, Niccolò; Girard, Nicolas; Greillier, L.; Lantuéjoul, Sylvie; Edwards, John; O’Brien, Mary; Reck, M.; Smit, Egbert F.; Schil, Paul Van; Postmus, P.E.; Ramella, Sara; Lievens, Yolande; Gaga, Mina; Peled, Nir; Scagliotti, Giorgio V.; Senan, Suresh; Paz‐Ares, Luis; Gückenberger, Matthias; McDonald, Fiona; Ekman, Simon; Čufer, Tanja; Gietema, Hester A.; Infante, Maurizio; Dziadziuszko, Rafał; Besse, Benjamin; Novello, Silvia

doi:10.1016/j.jtho.2018.08.530

Cited by 7 publications

(9 citation statements)

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“…5,6 In an attempt to provide a definition of sOM NSCLC, the European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Group (LCG) developed a consensus definition based on clinical cases of sOM disease, a European survey on sOM disease, and a systematic review of the currently requested staging methods and definitions of the term synchronous oligometastatic used in clinical trials. [7][8][9] Here we report the results of the systematic review.…”

Section: Introductionmentioning

confidence: 99%

Defining Synchronous Oligometastatic Non–Small Cell Lung Cancer: A Systematic Review

Giaj-Levra

Durieux

et al. 2019

Journal of Thoracic Oncology

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Introduction: Synchronous oligometastatic (sOM) disease is an oncological concept characterized by a limited cancer burden. Patients with oligometastasis could potentially benefit from local radical treatments. Despite the fact that the sOM condition is well recognized, a universal definition, including a specific definition for NSCLC, is not yet available. The aim of this systematic review was to summarize the definitions of and staging requirements for use of the term synchronous oligometastatic in the context of NSCLC. Methods:The key issue was formulated in one research question according to the population, intervention, comparator, and outcomes strategy. The question was introduced in MEDLINE (OvidSP). All articles dealing with sOM NSCLC and providing a definition of synchronous oligometastasis in NSCLC were selected and analyzed.Results: A total of 21 eligible articles focusing on sOM NSCLC were retrieved and analyzed. In 17 studies (81%), patients had to be staged with magnetic resonance imaging or computed tomography of the brain, thoracic and abdominal computed tomography, and positron emission tomography. The total number of metastases allowed in the definitions ranged from one to eight, but in 38.1% of studies the maximum number was 5. Most of the publications did not define the number of involved organs or the maximum number of metastases per organ. For mediastinal lymph

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Section: Introductionmentioning

confidence: 99%

Defining Synchronous Oligometastatic Non–Small Cell Lung Cancer: A Systematic Review

Giaj-Levra

Durieux

et al. 2019

Journal of Thoracic Oncology

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“…However, to be able to design and compare trials, a single definition is needed. The EORTC oligometastatic definition group has formulated a consensus statement on the definition of synchronous oligometastatic NSCLC [16]. This definition should be prospectively tested in future randomised trials and in the EORTC-ESTRO (European Society for Therapeutic Radiation and Oncology) OligoCare project (a pragmatic observational basket study to evaluate radical radiotherapy for oligometastatic cancer patients).…”

Section: Discussionmentioning

confidence: 99%

“…Only for one trial, overall survival (OS) results have been reported, with a median OS of 41.2 months for the LRT arm and 17 months for the control arm [15]. The inclusion criteria such as the number of metastases, considering the primary and/or mediastinal lymph nodes, eligibility of patients with driver mutations and treatment sequence varied (Table 1) [16].…”

Section: Introductionmentioning

confidence: 99%

Defining oligometastatic non-small cell lung cancer: A simulated multidisciplinary expert opinion

Hendriks

Dooms

Berghmans

et al. 2019

European Journal of Cancer

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Introduction: Synchronous oligometastatic non-small cell lung cancer (NSCLC) definition varies from 1 metastasis in 1 organ (tumour-node-metastasis 8 [TNM8]), 1e3 metastases (European Society for Medical Oncology [ESMO]), 3 metastases (including mediastinal nodes [MLN]) after systemic treatment to 3e5 metastases in ongoing trials. A single definition is however needed to design/compare trials. To assess oligometastatic NSCLC definitions used by clinical experts in daily practice and its evolution, we redistributed a 2012 case-based survey (Dooms, the World Congress of Lung Cancer 2013). Methods: In December 2017, 10 real-life multidisciplinary team (MDT) discussed patients (good condition, no significant comorbidities, 18 F-fluorodeoxyglucose positron emission tomography/brain magnetic resonance imaging staged, all < 5 metastases, 9/10 3 metastases, oncogene-addicted or wild-type) were distributed to 33 international NSCLC experts involved in the European Organisation for Research and Treatment of Cancer oligometastatic NSCLC consensus group, questioning is this oligometastatic disease and if oligometastatic, which treatment proposal. The answers provided in 2017 were compared with the 2012 answers; real-life treatment and survival of the patients was added. Results: Twenty-six of 33 experts (24 centres) replied: 8 medical oncologists, 7 pulmonologists, 7 radiation oncologists, 4 thoracic surgeons. Sixty-two percent of respondents discussed the cases with their MDT. One case had 100% oligometastatic consensus, and 3 cases had >90% consensus; the number of treatment proposals varied between 3 and 8. Radical treatment was more often offered in case of single metastasis or N0. Compared with 2012, there was a trend towards a more conservative oligometastatic definition and chemotherapy was more frequently included in the treatment proposal. Conclusions: Oligometastatic NSCLC definition was conservative. The number of organs, MLN status and radical treatment possibility seem to be components of daily practice oligometastatic definition.

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“…In an attempt to come to a consensus definition, which would aid the development of clinical trials, the European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Group organized a consensus meeting (13). It was proposed that oligometastases are defined as a maximum of five metastases and three organs.…”

Section: Definition Of Oligometastasesmentioning

confidence: 99%

Changing equipoise in the landscape of radiation for oligometastatic lung cancer

Schroeder

Leenders

Iyengar

et al. 2019

Transl. Lung Cancer Res.

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There is growing interest in exploring use of local therapies in the management of oligometastatic non-small cell lung cancer (NSCLC) to provide durable local and distant disease control. Prospective phase II studies have incorporated local therapy (predominantly stereotactic ablative radiotherapy or SABR) to both primary and metastatic sites. For patients who received these treatments, median progression-free survival (PFS) and overall survival (OS) exceeded that of historical controls treated with systemic therapy alone (9.7-23.5 and 13.5-41.2 months, respectively). Additionally, three trials randomized oligometastatic NSCLC patients to standard of care systemic therapy regimens vs. local consolidative therapy (LCT) plus standard of care systemic therapy (or observation) and all demonstrated a significant improvement in PFS, with two showing OS benefits to date. Notably, a majority of these trials selected patients with at least stable disease after completion of systemic therapy for local therapy and defined the oligometastatic state as one with no more than five metastatic sites spread across three organs. For patients with oligometastatic NSCLC, there are many important factors that should drive use and timing of local therapy, including metastatic presentation sequence (synchronous vs. metachronous), extent of disease (number and distribution of sites), and quality of life goals. The referenced clinical trials accrued patients prior to the approval of immunotherapy for metastatic NSCLC, so the benefits of any local therapy in this setting remain uncertain. To ultimately clarify the role of local therapy in oligometastatic NSCLC in the era of improving systemic therapy efficacy (i.e., immunotherapy and targeted therapy combinations with cytotoxics), we recommend enrollment in in phase III studies with OS endpoints (i.e., NRG LU 002 and SARON) whenever possible. These and other important issues associated with local therapy for oligometastatic NSCLC are reviewed in this paper.

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MA25.02 Searching for a Definition of Synchronous Oligometastatic (sOMD)-NSCLC: A Consensus from Thoracic Oncology Experts

Cited by 7 publications

References 0 publications

Defining Synchronous Oligometastatic Non–Small Cell Lung Cancer: A Systematic Review

Defining Synchronous Oligometastatic Non–Small Cell Lung Cancer: A Systematic Review

Defining oligometastatic non-small cell lung cancer: A simulated multidisciplinary expert opinion

Changing equipoise in the landscape of radiation for oligometastatic lung cancer

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