Abstract 669P
Background
The efficacy of local ablative therapy (LAT) for oligoprogressive disease (OPD) after chemotherapy has been evaluated in non-small cell lung cancer (NSCLC), but the efficacy of LAT for OPD after combined chemotherapy and immunotherapy has not yet been investigated. We aimed to retrospectively analyze the clinical course of cases where combined chemotherapy and immunotherapy were effective and to evaluate the efficacy of LAT for OPD.
Methods
From January 2019 to December 2021, 384 cases of advanced or recurrent NSCLC who underwent initial immunotherapy combined chemotherapy and were confirmed to be progression-free for ≥3 months at 8 facilities of the Okayama Lung Cancer Study Group were retrospectively analyzed. Progression was defined as oligo-progression (OPD) if the progressing lesions were ≤5 cm within 3 lesions, and as multi-progression (MPD) for other types of progression.
Results
Median age: 72 years (rage 36-93), male / female = 299/85, PS: 0-1/2-4 = 302/81, non-smoker / smoker = 50/332, stage: recurrent / III / IV = 68/65/251, adenocarcinoma / squamous cell carcinoma / others = 242/102/40, PD-L1: TPS <1% / 1-49% / ≥50% / unknown = 91/103/142/48. Patterns of progression: no progression / OPD / MPD = 68/143/165. Median observation period: 22.9 months. Median overall survival for OPD and MPD was 24.4 vs 16.2 months (p < 0.001), and median post-progression survival was 12.2 vs 7.4 months (p < 0.001). Local therapy (LAT) was performed in 21 OPD cases (15%), and the median post-progression survival for LAT cases and non-LAT cases was 13.0 vs 11.0 months (p = 0.81). LAT cases had a higher rate of brain metastases progression compared to non-LAT cases (38% vs 4%), LAT for brain metastasis consisting of surgery + stereotactic radiotherapy (SRT): 1 case, SRT: 5 cases, whole brain irradiation: 2 cases. The non-RECIST-PD rate was also higher (29% vs 4%).
Conclusions
In this analysis, OPD cases had a better prognosis than MPD cases. However, LAT for OPD did not show any effect on extending post-progression survival. The higher rate of brain metastasis in LAT cases suggests that the implementation of LAT is strongly influenced by patient-specific factors.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
A study / academic group.
Funding
Has not received any funding.
Disclosure
T. Ninomiya: Financial Interests, Personal, Speaker’s Bureau: Boehringer Ingelheim, Chugai Pharmaceutical, AstraZeneca, Eli Lilly, Eisai. K. Ninomiya: Financial Interests, Personal, Speaker’s Bureau: Boehringer Ingelheim, Chugai Pharmaceutical, AstraZeneca, Eli Lilly, Kyowa Kirin, Nippon Kayaku, Taiho Pharmaceutical, MSD K.K., Ono Pharmaceutical, Takeda Pharmaceutical, Pfizer Inc., Bristol Myers Squibb, Elekta K.K., Janssen Pharma, Daiichi Sankyo, Amgen K.K. K. Hotta: Financial Interests, Personal, Speaker’s Bureau: Boehringer Ingelheim, Chugai Pharmaceutical, AstraZeneca, Eli Lilly, MSD, BMS, Ono Pharmaceutical, Nippon Kayaku, Amgen, Taiho Pharma, Merck; Financial Interests, Personal, Research Funding: Bristol Myers Squibb, MSD, AstraZeneca, Chugai Pharmaceutical, Eli Lilly, BMS, AbbVie, Ono Pharmaceutical. All other authors have declared no conflicts of interest.