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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Monday, May 13, 2024
Michael Skwarski, PhD, of Guy’s and St. Thomas’ National Health Service (NHS) Foundation Trust, London, and colleagues conducted reportedly the largest multinational review of clinical outcomes after radiotherapy among patients with non–small cell lung cancer (NSCLC) whose disease progressed on immune checkpoint inhibitors. The results of their study, presented during the European Society for Radiotherapy and Oncology (ESTRO) 2024 Annual Congress (Abstract 185), provide further insight on clinical decision-making for oligoprogressive NSCLC in patients receiving immunotherapy.
“Promising outcomes were observed among patients irradiated for oligoprogression on immune checkpoint inhibitors, especially those who harbored visceral oligoprogressive lesions and received intermediate radiation doses,” concluded the investigators. “Patients who attained a favorable local response and individuals receiving immune checkpoint inhibitors for longer periods before oligoprogression also had better survival outcomes.”
Oligoprogression was defined as more than five progressive in a patient while on immune checkpoint inhibitors; 103 patients were identified. Participants were managed with any dose of radiation between January 2010 and April 2023 at the Dana-Farber/Harvard Cancer Center or the Guy’s and St. Thomas’ or Oxford University Hospitals NHS Foundation Trusts. Individuals were eligible if they received radiotherapy to all oligoprogressive lesions while other disease sites responded to or remained stable on immune checkpoint inhibitors.
The median number of oligoprogressive lesions was one, and the median duration of immune checkpoint inhibitor therapy before diagnosis was 5.55 months. The median overall survival and progression-free survival were 23.46 and 6.90 months, respectively. Patient demographics, radiation modality, and oligoprogressive lesion response were not found to be associated with survival; however, local control of irradiated lesions correlated with intermediate radiation doses (P = .01) and local response to radiation therapy (P = .007).
Local response to radiation therapy (P = .006) and duration of the last immune checkpoint inhibitor before disease progression (P = .03) were found to be associated with favorable overall survival. Furthermore, visceral anatomic sites of oligoprogression after radiation therapy seemed to be linked to improved progression-free survival (P = .01).
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