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Baktiar Hasan
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MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Oligometastatic NSCLC
- Presentations: 3
- Moderators:
- Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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MA25.01 - EORTC Lung Cancer Group Survey to Define Synchronous Oligometastatic Disease in NSCLC (ID 13770)
13:30 - 13:35 | Author(s): Baktiar Hasan
- Abstract
- Presentation
Background
Synchronous oligometastasic disease (sOMD) has been described as a separate disease entity; however there is no consensus on what specific criteria constitutes sOMD in NSCLC. A consensus group (CG) was formed aiming to agree on a common sOMD definition (sOMD-d) that could be used in future clinical trials. A European survey was circulated to inform the discussion on sOMD-d.
a9ded1e5ce5d75814730bb4caaf49419 Method
An EORTC Lung Cancer Group (LCG) / sOMD-d CG survey containing 31 questions on sOMD-d was distributed between 14/12/17 and 19/02/18 to EORTC LCG, sOMD-d CG, and several European thoracic oncology societies’ members.
4c3880bb027f159e801041b1021e88e8 Result
444 responses were analyzed (radiation oncologist: 55% [n=242], pulmonologist: 15% [n=66], medical oncologist: 14% [n=64]; 78% with >5 years’ experience in treating NSCLC). Belgium (14%, n=62), Italy (12%, n=55), Germany (11%, n=47), and Netherlands (10%, n=44) contributed most. 81% (n=361) physicians aimed to cure sOMD NSCLC patients and 82% (n=361) included the possibility to treat the patient with radical intent in their sOMD-d. The maximum number of metastases considered in sOMD-d varied: 19%, 42%, 4%, and 17% replied <2, 3, 4, and >5 metastases, respectively. 79% (n=353) stated that the number of organs involved was important for sOMD-d, and most (80%, n=355) considered that only <3 involved organs (excluding primary) should be included in the definition. 317 (71.7%) allowed mediastinal lymph node involvement (MLN) in the sOMD-d, and 22.1% of them counted MLN as a metastatic site. For 195/327 (60%), when N2/N3 disease is included in the sOMD-d, there is no specific issue regarding the MLN volume/location as long as radical treatment is possible. 384 (86%) considered pulmonary metastasis (outside primary tumor: M1a) as metastatic site. Most physicians confirmed sOMD patients with brain MRI (91%, n=403) and PET-CT (98%, n=437). For mediastinum staging, most (64%, n=285) respondents stated that histology/cytology should be obtained when PET-CT shows suspected lymph nodes or in case of a central primary tumor. Pathology proof of metastatic disease was necessary in sOMD for 315 (71%) physicians, and 37% (n=163) acknowledged that histology should be obtained from at least from one metastatic site. Preferred primary outcome parameter in clinical trials of sOMD was overall survival (73%, n=325).
8eea62084ca7e541d918e823422bd82e Conclusion
Although certain consensual answers were obtained (81% aimed to cure and >90% mandated baseline imaging with PET-CT and brain MRI), a number of issues remain unresolved and will require further discussion by a panel of experts to agree on a sOMD-d.
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MA25.02 - Searching for a Definition of Synchronous Oligometastatic (sOMD)-NSCLC: A Consensus from Thoracic Oncology Experts (ID 13452)
13:40 - 13:45 | Author(s): Baktiar Hasan
- Abstract
- Presentation
Background
Recent prospective single centre studies reported improved outcomes in patients with sOMD-NSCLC who were treated with radical intent. Since then sOMD has been perceived as a separate disease entity. However, a clear definition of sOMD-NSCLC is lacking. We aimed to develop a definition and diagnostic criteria of sOMD-NSCLC following a consensus process.
a9ded1e5ce5d75814730bb4caaf49419 Method
A European multidisciplinary consensus group was established with representatives from different scientific societies. Consensus questions were extracted from a survey, case series and a systematic review. The questions were discussed, and the statement formulated during a consensus meeting in Dublin (23.01.18).
4c3880bb027f159e801041b1021e88e8 Result
Summary of consensus statement
Defining sOMD-NSCLC
Definition of sOMD is relevant for patients in whom a radical treatment is technically feasible with acceptable toxicity, taking into account all sites, that may modify the course of the disease leading to a long-term disease control.
All sites must be technically and safely treatable.
The maximum number of metastases/organs meeting the criteria involved will depend on the possibility of offering a treatment strategy with radical intent, taking into account local control and toxicity. Based on the systematic review, a maximum of 5 metastases and 3 organs is proposed.
Diffuse serosal metastases and bone marrow involvement are excluded.
Mediastinal lymph node (MLN) involvement should be considered as locoregional disease in the definition of sOMD-NSCLC.
MLN involvement is of importance in determining if a radical local treatment of the primary tumour may be applied and the MLN will not be counted as a metastatic site.
Staging of sOMD-NSCLC
PET-CT and brain imaging are considered mandatory.
In case of a solitary liver metastasis a dedicated MRI of the liver and for a solitary pleural metastasis, thoracoscopy and biopsies of distant ipsilateral pleural sites are advised.
Staging of the mediastinum requires a minimum of a FDG-PET scan, with pathological confirmation preferred if this influences the treatment strategy.
Pathological proof is required unless the MDT decides that the risk outweighs the benefit. Pathology proof is advised for single metastatic location and if it may change the therapeutic strategy, confirmation of the MLN involvement is recommended.
8eea62084ca7e541d918e823422bd82e Conclusion
A multidisciplinary consensus statement on the definition and staging of sOMD-NSCLC was formulated taking into account results of a European survey, a systematic review and case discussion. This statement might be helpful to standardise inclusion criteria in future clinical trials. However, the definition of sOMD may change over time when more prospective data will become available.
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MA25.03 - Defining Oligometastatic Non-Small Cell Lung Cancer (NSCLC): An Evolving Multidisciplinary Expert Opinion (ID 12573)
13:35 - 13:40 | Author(s): Baktiar Hasan
- Abstract
- Presentation
Background
Synchronous oligometastatic NSCLC definition varies between: 1 metastasis in 1 organ (TNM8), 1-3 metastases (ESMO), ≤3 metastases after systemic treatment with mediastinal nodes (MLN) counting as 1 site (Gomez, Lancet Oncol 2016) to 3-≥5 metastases in ongoing trials. A single definition is however needed to design and compare trials. To assess synchronous oligometastatic NSCLC definitions used by clinical experts in daily practice and its evolution, we redistributed a 2012-case based survey (Dooms et al, presented at WCLC 2013).
a9ded1e5ce5d75814730bb4caaf49419 Method
In December 2017, 10 real-life multidisciplinary team (MDT) discussed patients (all good condition, no significant comorbidities, 18FFDG-PET and brain MRI staged, all < 5 metastases, 9/10 ≤ 3 metastases, oncogene-addicted or wildtype NSCLC) were distributed to 33 international NSCLC experts involved in the EORTC oligometastatic NSCLC consensus group, questioning: 1) can you discuss these cases in your MDT?, 2) do these patients have oligometastatic disease? and 3) what is your treatment proposal for the oligometastatic disease patients? Current answers were compared to the previous ones, and the real-life treatment and survival of the patients was added.
4c3880bb027f159e801041b1021e88e8 Result
26/33 experts (24 centers) replied: 8 medical oncologists, 7 pulmonologists, 7 radiation oncologists, 4 thoracic surgeons. 62% discussed the cases in their MDT. 1 case had 100% oligometastatic disease consensus, 3 cases had > 90% consensus, the number of treatment proposals varied between 3 to 8 (Table). Radical treatment was more often offered in case of a single metastasis or N0 status. Compared to 2012 there was a trend towards a more conservative oligometastatic definition and chemotherapy was more often included in the treatment proposal.
table 1 Case TNM8 oligometastatic
yes answer %
2012 / 2017Number of tx
proposals
2012 / 2017
Radical tx
answers %
2012/2017Real life radical
tx intent
real life survival
(months) /
5Y survival
EGFR+ T2aN3M1c (3 brain mets) 55 / 38 2 / 5 27 / 23 - 40.1 / - EGFR+ T4N0M1a (ground glass) 36 / 35 4 / 3 45 / 35 + 65.2 / + T2aN1M1b (solitary renal) 91 / 96 5 / 5 100 / 92 + 8.3 / - T1bN3M1b (solitary adrenal) 73 / 58 4 / 5 36 / 54 + 66.1 / + T2bN1M1c (adrenal + pelvic node) 55 / 50 2 / 5 36 / 46 - 18.6 / - T2aN0M1c (3 liver mets) 64 / 69 4/ 5 27 / 62 - 51.5 / - T2aN2M1b (solitary bone) 91 / 92 4 / 5 73 / 85 + 13.4 / - T3N1M1c (2 brain mets) 91 / 96 3 / 8 73 / 85 + 39.6 / - T2aN0M1c (1 lung, 1 pancreas) 82 / 69 5 / 4 64 / 50 + 74.0 / + T1bN0M1b (solitary bone) 100 / 100 3 / 5 82 / 92 + 11.6 / -
8eea62084ca7e541d918e823422bd82e Conclusion
Synchronous oligometastatic NSCLC definition was more conservative than in 2012 and linked to radical intent of treatment. Number of organs, MLN status and possibility for radical treatment seem to be components of daily practice synchronous oligometastatic definition.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.06-36 - EORTC 1205: Randomized Phase II Study of Pleurectomy/Decortication Preceded or Followed by Chemotherapy in Early Stage MPM (ID 11962)
16:45 - 18:00 | Author(s): Baktiar Hasan
- Abstract
Background
Case series show a prolonged survival in resectable malignant pleural mesothelioma (MPM) with a combined modality approach of surgery and chemotherapy.
Extrapleural pneumonectomy is the most commonly used surgical procedure in MPM, but is associated with a significant morbidity; the MARS trial (Treasure, Lancet Oncol 2011) suggests no outcome benefit and a possible harm to the patient.
Retrospective studies suggest a better outcome with lung sparing resection (extended pleurectomy/decortication, e-P/D), but the procedure lacks uniformity and standardization. The optimal sequence of surgery and chemotherapy, the latter given either adjuvant or neo-adjuvant has not yet been determined.
a9ded1e5ce5d75814730bb4caaf49419 Method
EORTC 1205 is a phase II, randomized (1:1) multi-centre trial comparing both approaches. Primary end-point is the successful completion of the multimodality treatment within 20 weeks. Secondary end-points are PFS, OS, treatment-failure-free survival (TFFS), toxicity/safety, operative mortality/morbidity and surgical quality and uniformity indicators.
Patients with pathologically proven malignant pleural mesothelioma of all histological subtypes, early stage (cT1-3 N0-2 M0 according to TNM 7), WHO-PS 0-1 and fit for chemotherapy and surgery are eligible.
No previous treatment, including prophylactic track irradiation, is allowed, except for diagnostic thoracoscopy with talc pleurodesis, which must be performed before randomization.
Patients are randomized between arm A - immediate surgery (extended pleurectomy/decortication), followed by 3 cycles of cisplatin 75 mg/m² plus pemetrexed 500 mg/m² on day 1 q3w, or arm B - deferred surgery, preceded by 3 cycles of chemotherapy.
4c3880bb027f159e801041b1021e88e8 Result
Currently 4 of 6 planned sites have opened and 10 patients have been randomized in 2 centres.
8eea62084ca7e541d918e823422bd82e ConclusionArm A (n=5)
Arm B (n=5)
Male/female
4/1
4/1
Median age
59.4 years [54.6-76.9]
67.1 years [58.8-69.1]
Median PS
1 [0-1]
0 [0-1]
Stage I/II/III
3/2/0
3/0/2
EORTC 1205 addresses the issue of optimally sequencing chemotherapy and e-P/D and will rigorously record the quality of the latter in a multicentre setting. Accrual is ongoing according to expectation. Updated interim results will be presented at the WCLC meeting.
6f8b794f3246b0c1e1780bb4d4d5dc53
