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Patients with oligometastatic lung cancer may live longer with surgery, but experts stress the need for multidisciplinary evaluation to guide treatment choices.
Patients with oligometastatic lung cancer may live longer with surgery: © stock.adobe.com.
All patients with oligometastatic non-small cell lung cancer (NSCLC) should undergo multidisciplinary evaluation, including surgical consultation, according to multiple study findings presented by Dr. Mara Antonoff at CURE’s Educated Patient® Young Onset Lung Cancer Summit.
“The main points here are that there were strong recommendations to support consideration of lung surgery in patients with oligometastatic lung cancer, [and] there's a strong recommendation that anyone with oligometastatic lung cancer should have a multidisciplinary evaluation, including consultation with an appropriately experienced thoracic surgeon.”
Antonoff is an associate professor and education program director in the Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center, in Houston.
In a study published by The Journal of Thoracic and Cardiovascular Surgery, patients who underwent lung surgery for oligometastatic disease had a median overall survival of 55.2 months versus 23.4 months for those who received radiotherapy, based on a median follow-up of 57.2 months. Ninety-day mortality was low in both groups (0% for surgery, 1.6% for radiotherapy). Although survival appeared higher with surgery, the authors noted that direct comparison is inappropriate due to strong selection bias and confounding factors. A survival curve showed consistently higher survival rates for surgery over time.
“I want to be very clear that you can't compare those two groups,” said Antonoff. “It's like comparing apples to oranges. We picked the healthiest, strongest people on whom to operate. So certainly, this doesn't mean surgery is better than radiation. What this means is that surgery should be considered in patients who have stage 4 disease, just as often as radiation is.”
Antonoff also discussed findings from a phase 2 study published in Lancet Oncology, which evaluated local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic NSCLC without progression after first-line systemic therapy.
These findings showed that local consolidative therapy improved progression-free survival and time to development of new metastatic lesions. This suggests either tumor or host response to suppress the spread of disease.
Median overall survival: the middle value of survival time for a group of patients, meaning half live longer and half live shorter than this time.
Progression-free survival: the length of time during and after treatment that a patient lives without the cancer worsening.
R0 resection: surgical removal of a tumor with no cancer cells seen at the margins, indicating complete tumor removal.
In addition, comprehensive local consolidative therapy (cLCT), defined as local treatment to all disease sites present at diagnosis, was associated with improved outcomes in patients with oligometastatic disease. Compared with maintenance therapy or observation in 49 patients, cLCT led to longer progression-free survival, delayed development of new metastases and improved overall survival.
Antonoff also discusses a retrospective analysis that included data from the phase 2 trial in addition to others, which had data over 18 years. A comparison of comprehensive local consolidative therapy (LCT) versus other approaches in patients with oligometastatic disease showed improved survival outcomes for those who received comprehensive LCT.
Among 121 patients who received comprehensive LCT, median survival was 29 months. In the group of 73 patients who received other treatments, median survival was 23 months.
One-year overall survival was 85% for the comprehensive LCT group versus 72% for the other group. At three years, survival was 43% versus 35%, and at five years, 32% versus 19%, respectively.
A retrospective study published in Clinical Lung Cancer evaluated 52 patients with oligometastatic NSCLC who underwent lung resection as part of local consolidative therapy aimed to evaluate surgical and long-term outcomes, according to Antonoff.
After a median follow-up of 94.6 months, the median overall survival was 51.7 months, and the median progression-free survival was 9.4 months.
Of the 52 patients, 47 (90%) received local consolidative therapy to all known sites of disease. R0 resection was achieved in 48 patients (92%). There were no deaths within 30 or 90 days after surgery.
Operations were reported as more difficult than usual in 22 patients (42%), with adherent or hard lymph nodes found in 15 patients (29%). Major complications included cardiovascular events in 10 patients (19%) and pulmonary complications in 8 patients (15%).
“I think this is really powerful when you think about the fact that we used to look at these types of curves and hope that we could take someone from six to nine months, all the way up to something like 11 to 13, months,” said Antonoff. “I mean, not great numbers, what we used to talk about in the past, and here we're looking at survival curves out to 60 months with a large number of patients still without any type of progression and alive. So, really remarkable and exciting results.”
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