1457P - Oligometastatic non-small cell lung cancer: Impact of local and systemic treatment approaches on clinical outcome

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.