Abstract 1457P
Background
Oligometastatic (OMD) non-small cell lung cancer (NSCLC) is a distinct but heterogeneous entity. Current guidelines recommend locally ablative therapy if technically feasible. Still, evidence is lacking to guide the choice of optimal multimodal treatment approaches and their impact on clinical endpoints.
Methods
Electronic medical records and clinical databases (years 2004 – 2022) from two major German comprehensive cancer centers were searched for cases with OMD NSCLC and treatment patterns. Prespecified OMD criteria included presence of ≤5 metastases in ≤2 organ systems, excluding primary tumor and mediastinal lymph nodes. Endpoints of this retrospective analysis were overall survival (OS), disease-free survival (DFS, first-line therapy until recurrence) and time-to-treatment failure (TTF).
Results
A total of 207 patients with OMD NSCLC were identified (46.9% female; median age 60.8; median follow-up 32 months; T1-2 vs. T3-4 51%/49%, N0-1 vs. N2-3 48%/52%, M1a 10.7%, metastases in one organ system 89.7% vs. multiple 10.3%). A dedicated OMD treatment strategy was explicitly specified in 164 patients (79.2%). Locally ablative therapy was applied to all tumor sites in 140 patients (67.6%), including radiotherapy (85%) and/or surgery (73.6%). Median OS of the full analysis cohort was 27.7 months, with 27.2% OS at 5 years. Median OS in patients receiving locally ablative therapy to all NSCLC sites amounted to 33.4 months (5y rate 35.7%) with a median DFS of 10.6 months (11.2% at 5y). First-line therapy included systemic therapy in 167 patients (80.7%), which was associated with doubling of DFS (median 12.2 vs. 6.0 months, p<0.001), and a trend towards improved OS. First-line chemoimmunotherapy was only approved in 2018/2019, thus limiting follow-up in this subgroup. Nevertheless, DFS (HR 0.5, p=0.025, 2y rate 46% vs. 15%) and TTF (HR 0.45, p<0.001) were greatly improved with first-line chemoimmunotherapy vs. chemotherapy.
Conclusions
Patients with OMD NSCLC benefit from multimodality approaches integrating systemic therapy and local ablation of all cancer sites. Although true freedom from recurrence is rare, extended OS can be achieved in a substantial fraction of patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M. Wiesweg: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Takeda, GSK, AstraZeneca; Financial Interests, Personal, Advisory Board: GSK, Novartis, Pfizer, Roche, Janssen, Daiichi Sankyo; Financial Interests, Institutional, Local PI: Takeda; Financial Interests, Institutional, Funding: Bristol Myers Squibb. T. Plönes: Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Invited Speaker: BMS, Roche, AstraZeneca. M. Metzenmacher: Financial Interests, Personal, Advisory Board: AstraZeneca, Bristol Myers Squibb, MSD, Novartis, Novocure, Pfizer, Roche, Takeda. W.E.E. Eberhardt: Financial Interests, Personal, Invited Speaker: AstraZeneca, Roche, Bristol Myers Squibb, MSD, Boehringer Ingelheim, Lilly, Amgen, Takeda, Pfizer, Novartis, Roche, Sanofi, AbbVie; Financial Interests, Personal, Advisory Board: AstraZeneca, Roche, Bristol Myers Squibb, MSD, Bayer, Lilly, Boehringer Ingelheim, Takeda, Pfizer, MSD, Novartis, Sanofi, AbbVie, Amgen, Janssen; Financial Interests, Institutional, Research Funding: AstraZeneca, Lilly, Bristol Myers Squibb; Non-Financial Interests, Personal and Institutional, Steering Committee Member: IASLC Staging Committee, M-track. A. Stenzinger: Financial Interests, Personal, Advisory Board: Aignostics, AstraZeneca, Janssen, Bayer, Seattle Genetics, Pfizer, MSD, Eli Lilly, Illumina, Thermo Fisher, Amgen; Financial Interests, Institutional, Advisory Board: BMS, Takeda, Novartis; Financial Interests, Personal, Invited Speaker: Roche, Incyte; Financial Interests, Institutional, Research Grant: Bayer, Chugai, BMS, Incyte. F. Weykamp: Financial Interests, Personal, Invited Speaker: AstraZeneca, MSD. M. Thomas: Financial Interests, Personal, Advisory Board: AstraZeneca, BeiGene, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Daiichi Sankyo, GSK, Janssen, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda; Financial Interests, Institutional, Research Funding: AstraZeneca, Bristol Myers Squibb, Merck, Roche, Takeda. M.H.H. Schuler: Financial Interests, Personal, Invited Speaker: Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Novartis, Roche; Financial Interests, Personal, Advisory Board: Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, GSK, Janssen, Merck Serono, Novartis, Roche, Sanofi, Takeda; Financial Interests, Institutional, Research Grant: AstraZeneca, Bristol Myers Squibb. P. Christopoulos: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Chugai, Pfizer, Novartis, MSD, Takeda, Roche, Daiichi Sankyo; Financial Interests, Personal, Writing Engagement: Gilead; Financial Interests, Personal, Invited Speaker: Thermo Fisher; Financial Interests, Institutional, Funding: AstraZeneca, Boehringer Ingelheim, Amgen, Novartis, Roche; Financial Interests, Personal, Funding: Takeda. All other authors have declared no conflicts of interest.
Resources from the same session
1422P - Comprehensive genomic profiling (CGP) changes management and improves survival in patients with advanced non-small cell lung cancer (aNSCLC)
Presenter: George Simon
Session: Poster session 20
1423P - Clinical impact of radiological diagnosis of lymphangitic carcinomatosis in patients with extensive non-small cell lung cancer treated with immunotherapy
Presenter: Anita Bolina
Session: Poster session 20
1424P - Outcome of thromboembolic events and its influence on survival time of advanced NSCLC patients receiving antiangiogenic therapy
Presenter: Wei-Fan Ou
Session: Poster session 20
1425P - Clinical utility of liquid biopsy for the early diagnosis of EGFR mutant advanced lung cancer in real-life setting (CLEAR)
Presenter: Rola El Sayed
Session: Poster session 20
1427P - Exploration of the value of leptomeningeal biopsy in diagnosing and treating non-small cell lung cancer with leptomeningeal metastasis
Presenter: Lin Cai
Session: Poster session 20
1428P - Clinical benefit of combination chemo-immunotherapy in first-line treatment for patients over the age of 65 or 75 with metastatic NSCLC
Presenter: Thierry Landre
Session: Poster session 20
1429P - Homologous recombination repair (HRR) gene mutation: A novel biomarker for precision genomics testing in advanced lung cancer
Presenter: Madhu Nagaraj
Session: Poster session 20
1430P - Excellent performance of a fast and fully-automated RNA based genefusion assay conducted on a large fusion positive non-small cell lung cancer cohort within a multicenter study
Presenter: Arndt Hartmann
Session: Poster session 20
1431P - The nNGM Preclinical Platform: Preclinical research to generate evidence for patients with non-small cell lung cancer harboring variants of unknown significance
Presenter: Martin Ziegler
Session: Poster session 20