Stereotactic radiotherapy concurrent to immune- or targeted therapy for oligometastatic NSCLC: clinical scenarios affecting prognosis

S. G. C. Kroeze, C. Fritz, D. Kaul, O. Blanck, K. H. Kahl, F. Roeder, S. Siva, J. J. C. Verhoeff, A. -L Grosu, M. Schymalla, M. Glatzer, M. Szuecs, M. Geier, G. Skazikis, I Sackerer, F. Lohaus, F. Eckert, M. Guckenberger

Research output: Contribution to journalMeeting AbstractAcademic

Abstract

Introduction: Oligometastatic NSCLC pts. may benefit from a more
aggressive treatment approach. However, the concept of “oligometastasis”
is complex: e. g. limited progression or resistance of disease to
systemic treatment. This study evaluated the outcome of stereotactic
radiotherapy (SRT) to oligoprogressive or oligoresistant NSCLC in
pts. receiving concurrent immuno- or targeted therapy.
Materials and methods: The international register study (TOaSTT)
collected data on metastatic NSCLC pts. receiving SRT concurrent
(≤30d) to immuno- or targeted therapy. Pts. were grouped in: SRT of
≤5 metastases without additional metastases (oligoprogression), SRT
of ≤5 progressive metastases with controlled disease of all other metastases
(oligopersistent), and SRT of ≤5 metastases with otherwise
mixed response/uncontrolled disease. OS, PFS, LC and time to systemic
therapy-switch after SRT were analyzed using Kaplan-Meier survival
curves and log rank testing. Toxicity was scored using CTCAE.
Results: SRT of 192 lesions in 108 pts. was performed between
7/2009–5/2018. Median age was 63 y (range 33–80). Driver mutations
were: EGFR 41%, ALK 14%, other 21%, unknown/no 24%. Median
FU was 18.7 (range 1–102) mo. 90% were ECOG 0–1. Median
1 (range 1–5) metastasis was treated. Targeted therapies were started
before SRT in 69%, during SRT in 8%, and after SRT in 23%. 60% received
an ALK- or EGFR-TKI, 31% PD-L1/PD-1 inhibitors, 8% bevacizumab.
Oligoprogressive and oligopersistent pts showed improved
OS compared to advanced metastatic disease (p=0.008). PFS was best
in oligoprogressive patients; median 20.1 vs 7 and 4.4 mo. (p=0.006).
LC was median 21.0, 12.0 und 9.0 mo: no sign. difference between
groups. After 1 y, 86%, 47% and 39% continued the same immuno- or
targeted therapy as before SRT. Severe acute toxicity were observed in
7%, late toxicity in 4%.
Conclusions: An excellent survival with limited toxicity was observed
when definitive SRT to a limited number of metastases was combined
with targeted- or immunotherapy in oligoprogressive and oligopersistent
NSCLC patients. SRT of metastatic sites allowed continuation
of targeted-, or immunotherapy in many patients. These observations
need to be further evaluated in prospective trials
Original languageEnglish
Pages (from-to)S49-S49
JournalStrahlentherapie und Onkologie
Volume195
Issue numberSuppl 1
Publication statusPublished - Jun 2019

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