Refining Treatment of Oligometastatic NSCLC Is a Work in Progress

By: Celeste L. Dixon
Posted: Friday, July 19, 2024

Adding local consolidative therapy to systemic therapy as maintenance treatment of oligometastatic non–small cell lung cancer (NSCLC) does not substantially change progression-free survival rates, according to recent trial results. Puneeth Iyengar, MD, PhD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues presented the outcomes of their randomized phase II study, NRG-LU002, during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 8506). In a separate interview, Dr. Iyengar said secondary analyses might be able to identify subgroups that could potentially benefit from local consolidative therapy, but for now, the option should not be used routinely.

A total of 215 patients were enrolled, all of whom had received four cycles of first-line systemic therapy and exhibited at least stable disease. Additionally, their metastatic NSCLC was marked by up to three extracranial metastatic sites. Most patients (90%) received immunotherapy-based systemic treatment; the rest had chemotherapy alone. Their median age was 65, and 78% had nonsquamous histology.

Patients were randomly assigned to receive maintenance systemic therapy (n = 81) or local consolidative therapy (radiation and/or surgery) followed by maintenance systemic therapy (n = 134) until disease progression, death, or intolerable toxicity, the investigators explained. This was the phase II part of the trial; it would proceed to phase III only if the estimated progression-free survival hazard ratio between the arms were less than 0.83.

Ultimately, though, the calculated hazard ratio was 0.93, not low enough for the trial to continue. Considering the patients treated with immunotherapy alone, the progression-free survival hazard ratio was 0.90. The estimated 1-year and 2-year progression-free survival rates were 48% and 36% in the maintenance-alone arm and 52% and 40% in the local consolidative therapy arm, respectively.

Adverse events were also problematic, the investigators noted. Of those reported as definitely, probably, or possibly related to treatment, there were more in the local consolidative therapy arm vs the maintenance-alone arm.

Disclosure: For full disclosures of the study authors, visit coi.asco.org.

2024 ASCO Annual Meeting

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