Oligometastatic non-small cell lung cancer: impact of local and contemporary systemic treatment approaches on clinical outcome
Oligometastatic (OMD) non-small cell lung cancer (NSCLC) is a distinct but heterogeneous entity. Current guidelines recommend systemic therapy and consolidation with local ablative therapy (LAT). However, evidence regarding the optimal choice of multimodal treatment approaches is lacking, in particu...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
[25 September 2024]
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| In: |
International journal of cancer
Year: 2025, Volume: 156, Issue: 4, Pages: 776-787 |
| ISSN: | 1097-0215 |
| DOI: | 10.1002/ijc.35199 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ijc.35199 Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.35199 
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| Author Notes: | Marcel Wiesweg, Claudia Küter, Johannes Schnorbach, Julius Keyl, Martin Metzenmacher, Jelena Cvetkovic, Felix Carl Saalfeld, Franziska Glanemann, Wilfried Eberhardt, Filiz Oezkan, Dirk Theegarten, Albrecht Stenzinger, Kaid Darwiche, Dirk Koschel, Felix Herth, Servet Bölükbas, Hauke Winter, Fabian Weykamp, Martin Wermke, Martin Stuschke, Till Plönes, Michael Thomas, Martin Schuler, Petros Christopoulos |
MARC
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| 520 | |a Oligometastatic (OMD) non-small cell lung cancer (NSCLC) is a distinct but heterogeneous entity. Current guidelines recommend systemic therapy and consolidation with local ablative therapy (LAT). However, evidence regarding the optimal choice of multimodal treatment approaches is lacking, in particular with respect to the integration of immunotherapy. This real-world study identified 218 patients with OMD NSCLC (2004-2023, prespecified criteria: ≤5 metastases in ≤2 organ systems) from three major German comprehensive cancer centers. Most patients had one (72.5%) or two (17.4%) metastatic lesions in a single (89.9%) organ system. Overall survival (OS) was significantly longer with a single metastatic lesion (HR 0.54, p = .003), and female gender (HR 0.4, p < .001). Median OS of the full cohort was 27.8 months, with 29% survival at 5 years. Patients who had completed LAT to all NSCLC sites, typically excluding patients with early progression, had a median OS of 34.4 months (37.7% 5-year OS rate) with a median recurrence-free survival (RFS) of 10.9 months (13.3% at 5 years). In those patients, systemic treatment as part of first-line therapy was associated with doubling of RFS (12.3 vs. 6.4 months, p < .001). Despite limited follow-up of patients receiving chemo-immunotherapy (EU approval 2018/2019), RFS was greatly improved by adding checkpoint inhibitors to chemotherapy (HR 0.44, p = .008, 2-year RFS 51.4% vs. 15.1%). In conclusion, patients with OMD NSCLC benefitted from multimodality approaches integrating systemic therapy and local ablation of all cancer sites. A substantial proportion of patients achieved extended OS, suggesting a potential for cure that can be further augmented with the addition of immunotherapy. | ||
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