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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Marcel Wiesweg - , University Hospital Essen (Author)
  • Claudia Küter - , University Hospital Essen (Author)
  • Johannes Schnorbach - , University Hospital Heidelberg (Author)
  • Julius Keyl - , University Hospital Essen (Author)
  • Martin Metzenmacher - , University Hospital Essen (Author)
  • Jelena Cvetkovic - , University Hospital Heidelberg (Author)
  • Felix Carl Saalfeld - , Department of Internal Medicine I, National Center for Tumor Diseases Dresden (NCT/UCC), German Cancer Research Center (DKFZ) (Author)
  • Franziska Glanemann - , University Hospital Essen (Author)
  • Wilfried Eberhardt - , University Hospital Essen (Author)
  • Filiz Oezkan - , University Hospital Essen (Author)
  • Dirk Theegarten - , University Hospital Essen (Author)
  • Albrecht Stenzinger - , University Hospital Heidelberg, National Center for Tumor Diseases (NCT) Heidelberg (Author)
  • Kaid Darwiche - , National Center for Tumor Diseases (NCT) West (Author)
  • Dirk Koschel - , Department of Internal Medicine I, Specialist hospital Coswig (Author)
  • Felix Herth - , University Hospital Heidelberg (Author)
  • Servet Bölükbas - , University Hospital Essen (Author)
  • Hauke Winter - , University Hospital Heidelberg (Author)
  • Fabian Weykamp - , German Cancer Research Center (DKFZ) (Author)
  • Martin Wermke - , Department of Internal Medicine I, National Center for Tumor Diseases Dresden (NCT/UCC), German Cancer Research Center (DKFZ) (Author)
  • Martin Stuschke - , University Hospital Essen (Author)
  • Till Plönes - , Department of Visceral, Thoracic and Vascular Surgery, National Center for Tumor Diseases Dresden (NCT/UCC), Helmholtz-Zentrum Dresden-Rossendorf, Specialist hospital Coswig, German Cancer Research Center (DKFZ) (Author)
  • Michael Thomas - , Translational Lung Research Center Heidelberg (TLRC) - DZL Heidelberg (Author)
  • Martin Schuler - , National Center for Tumor Diseases (NCT) West (Author)
  • Petros Christopoulos - , Translational Lung Research Center Heidelberg (TLRC) - DZL Heidelberg (Author)

Abstract

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.

Details

Original languageEnglish
JournalInternational journal of cancer
Publication statusE-pub ahead of print - 25 Sept 2024
Peer-reviewedYes

External IDs

Scopus 85205228821
ORCID /0000-0002-4095-8649/work/173989369

Keywords

Sustainable Development Goals