Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 22Use of local consolidative therapy improves progression-free survival for patients with oligometastatic NSCLC who receive systemic induction therapy
3:26 minutes.
TRANSCRIPTION:
DR BLUMENSCHEIN: We came up with the thought that we know there’s data out there with oligometastatic disease with regards to brain mets and improvement in outcome and when patients present with that particular scenario. And in other tumor types they’ve looked at treating oligometastatic disease. And so we put a proposal together that was initially single center at MD Anderson and expanded to several other centers, where we had patients who had metastatic disease, and we quantified by the number of sites that were involved, would receive chemotherapy. And those patients that benefited from chemotherapy were then randomized either to continuation chemotherapy maintenance, observation or immediately going to some local therapy consolidation either with radiation therapy to the various sites or even to surgical resection. And those patients who had progressed later on had the option to get consolidation at progression with radiation. And so this study actually closed early because when they did midterm analysis on it, there was a significant survival benefit or progression-free survival benefit, excuse me, for patients who received treatment for their oligometastatic disease. And this is something that we’re actually carrying forward now in several new iterations of this approach. And I think there’s some other cooperative group trials, both in the NRG and in SWOG, which are under proposal or soon to initiate investigating the same idea. DR LOVE: What about in your own practice? Do you do this? DR BLUMENSCHEIN: Yes. So if a patient does present with oligometastatic disease, I think it’s important to give them systemic therapy up front, just to make sure that there’s no other disease lurking that you haven’t identified. And if the patient does well, there’s not a significant tumor burden that’s developing, then I think consolidation with radiation therapy makes sense. I’ve actually done this in small cell lung cancer. I had a patient who had extensive-disease small cell lung cancer, will develop that after getting chemoradiation with an isolated adrenal metastasis. We treated him with etoposide and cisplatin. And then about a year and a half ago, he finished radiation therapy of that one metastatic site, and he’s remained disease free since that time. DR LOVE: Can you give some examples of sites of oligometastatic disease that you’d use local therapy on? DR BLUMENSCHEIN: Sure. Certainly. So the liver, bony metastasis and lung metastasis, as well as brain metastasis. So those are the general sites that we’ve seen. DR LOVE: I don’t know how often you see in lung cancer predominantly bone metastasis — I’m sure it’s not the typical case — but do you see cases like that? And would you ever consider something like radium-223? DR BLUMENSCHEIN: So radium-223 is not approved yet in non-small cell lung cancer. I think it’s an interesting compound. And it’s relatively nontoxic compared to say, strontium. And I do think it’s a potential therapeutic option if they can get supporting data. I think it makes sense. It’s interesting. We don’t see bone-only disease that commonly — it’s a rare thing — but occasionally it does happen. Or someone will have diffuse disease, which is not really amenable to radiation therapy. And as you know with chemotherapy, the response rates are roughly 25% in the front line and they drop down to roughly 10% to 12% with chemotherapy or 18% with immunotherapy. So I think having something like that would be a reasonable approach, especially for patients who have symptomatic bony metastases. |