Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC

Abstract

Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting.

The Effect of immunotherapy on oligometastatic non-small cell lung cancer patients by sites of metastasis

“…Recently, a number of studies have shown that LT improved the prognosis of patients with oligometastatic NSCLC ( 27 , 28 ). However, several studies have also shown that immunotherapy was effective for treatment of patients with oligometastatic NSCLC, especially for those at high risk of distant metastases ( 29 , 30 ). In the most recent NCCN guidelines, immunotherapy is a recognized front-line treatment approach for metastatic NSCLC ( 31 ).…”

Can Liquid Biopsy Based on ctDNA/cfDNA Replace Tissue Biopsy for the Precision Treatment of EGFR-Mutated NSCLC?

“…At the same time, drug resistance is also a major challenge for patients receiving targeted therapy. In addition, approximately 30–50% of advanced lung cancers are oligometastatic at initial diagnosis [ 143 , 144 , 145 ]. Whether MRD can guide the next steps of systemic therapy when the metastatic lesions of patients with oligometastases are treated with radical therapy deserves further exploration.…”

Role of Local Treatment for Oligometastasis: A Comparability Based Meta-Analysis

“… Forest plots of pooled analyses regarding overall survival, including all studies (A), studies with reliable comparability (B), and randomized controlled trials (C) [ 7 , 8 , 21 – 31 , 34 , 35 , 37 – 45 , 47 – 53 , 55 – 66 , 68 – 71 , 73 ]. BDC, biliary duct cancer; HCC, hepatocellular carcinoma; H&N, head and neck; LCT, local consolidative therapy; NSCLC, non-small cell lung cancer; RCC, renal cell carcinoma; SCLC, small cell lung cancer; 2yCSS, 2-year cancer-specific survival; 5yCSS, 5-year cancer-specific survival.…”