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

Abstract

IntroductionThe efficacy of immunotherapy for treatment of patients with oligometastatic non-small cell lung cancer (NSCLC) at different metastatic sites remains controversial. We investigated the effect of different metastatic sites on immunotherapy for oligometastatic NSCLC following local treatment (LT).MethodsWe retrospectively analyzed patients with oligometastatic NSCLC from the latest 2018 registry on the SEER Stat software (8.3.9. Version) and a Chinese single-center cohort. The effects of immunotherapy on OS (overall survival) and CSS (cancer specific survival) were estimated for patients with different metastatic sites.ResultsA total of 483 patients in the SEER-18 database and 344 patients in the single-center cohort were included. Immunotherapy was significantly correlated with improved OS (SEER: Hazard ratio 0.754, 95% CI 0.609–0.932; P=0.044; China: Hazard ratio 0.697, 95% CI 0.542–0.896; P=0.005) and CSS (SEER: Hazard ratio 0.743, 95% CI 0.596–0.928; P=0.009; China: Hazard ratio 0.725, 95% CI 0.556–0.945; P=0.018). Subgroup analysis showed that OS was improved after immunotherapy in the BRM (SEER: Hazard ratio 0.565, 95% CI 0.385–0.829; P=0.004; China: Hazard ratio 0.536, 95% CI 0.312–0.920; P=0.024) and MOM (SEER: Hazard ratio 0.524, 95% CI 0.290–0.947; P=0.032; China: Hazard ratio 0.469, 95% CI 0.235–0.937; P=0.032) subgroups, but not in the BOM (SEER: P=0.334; China: P=0.441), LIM (SEER: P=0.301; China: P=0.357), or OTM (SEER: P=0.868; China: P=0.489) subgroups.ConclusionsThis study showed that immunotherapy conferred survival benefits on patients with oligometastatic NSCLC. Our subgroup analysis suggested that patients with oligometastatic NSCLC in the brain or multiple organs may particularly benefit from aggressive front-line therapies.

Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

“…Unfortunately, while DLTs, particularly SRT, are widely used in clinical practice to manage OMD, there is limited evidence to support their use. A review of scientific literature from PubMed in the past year (when a peak of publications is registered) reveals a high number of heterogeneous, retrospective, and small-scale clinical studies conducted in real-world settings [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. While these studies are important, their results cannot formally change the standard of therapy.…”

“…While these studies are important, their results cannot formally change the standard of therapy. The evidence ranges from case reports and retrospective series [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] to phase III randomized trials [ 69 ] such as the SINDAS trial. This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy).…”

“…The median survivals achieved in these studies with SRT are higher than those reported in the poly-metastatic setting, 30.8 and 53.4 months, respectively, confirming that OMD has a good prognosis. However, examples of systemic approaches have also been pursued and published in the past year in OMD, including immuno-plus chemotherapy [ 61 , 62 ] and immune therapy plus SRT [ 66 ]. These studies are retrospective, heterogeneous (patients received different treatments before and/or after the therapeutic approach for OMD), and lacking in comparison with a “control” arm.…”