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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Thursday, December 19, 2024
A first-line regimen of thoracic radiotherapy given concurrently with EGFR tyrosine kinase inhibitors (TKIs) may offer more survival benefit than TKIs alone for patients with oligo-organ metastatic non–small cell lung cancer (NSCLC) who have EGFR mutations, according to the results of a phase III clinical trial published in the Journal of Clinical Oncology. Hongfu Sun, MD, of Shandong Academy of Medical Sciences, Jinan, China, and colleagues reported that compared with TKIs alone, the addition of thoracic radiotherapy yielded significantly better progression-free survival, which was the primary endpoint (hazard ratio [HR] = 0.57; P = .004), and overall survival (HR = 0.62; P = .029), a secondary endpoint.
The median progression-free survival was 10.6 months in the TKI-alone group and 17.1 months in the experimental group (TKIs plus thoracic radiotherapy). The median overall survival was 26.2 months and 34.4 months in the TKI-alone and experimental arms, respectively.
The other secondary endpoint was treatment-related adverse events. Although the experimental regimen was associated with a higher incidence of severe treatment-related adverse events—11.9% vs 5.1% for TKIs alone—the team called the treatment-related adverse events profile in the experimental arm “acceptable and tolerable.”
The trial enrolled 118 patients between 2016 and 2022. The patients in the experimental group received 60 Gy of radiation to their primary lung tumor and positive regional lymph nodes. Radiotherapy for metastases to other sites was determined by clinicians.
Dr. Sun and co-investigators revealed that patients with brain metastases were not excluded. They enrolled patients with no more than three metastatic organs, regardless of the number of metastatic sites, they explained. “The comparative survival analysis between different metastatic sites suggested nonsignificant differences in prognosis,” the team wrote, supporting “the expansion from oligo-site metastasis to oligo-organ metastasis.”
Disclosure: Dr. Sun reported no conflicts of interest. For full disclosures of the other study authors, visit ascopubs.org.
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