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Stephanie G.C. Kroeze

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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      173P - Stereotactic radiotherapy concurrent to immune or targeted therapy for oligometastatic NSCLC: Clinical scenarios affecting survival (ID 193)

      12:30 - 13:00  |  Presenting Author(s): Stephanie G.C. Kroeze

      • Abstract
      • Slides


      Oligometastatic NSCLC pts. may benefit from a more aggressive treatment approach. However, the concept of “oligometastasis” is complex: e.g. limited progression or resistance of disease to systemic treatment. This study evaluated the outcome of stereotactic radiotherapy (SRT) to oligoprogressive or oligoresistant NSCLC in pts. receiving concurrent immuno- or targeted therapy.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      The international register study (TOaSTT) collected data on metastatic NSCLC pts. receiving SRT concurrent (≤30d) to immuno- or targeted therapy. Pts. were grouped in: SRT of ≤ 5 metastases without additional metastases (oligoprogression), SRT of ≤ 5 progressive metastases with controlled disease of all other metastases (oligopersistent), and SRT of ≤ 5 metastases with otherwise mixed response/ uncontrolled disease. OS, PFS, LC and time to systemic therapy-switch after SRT were analyzed using Kaplan-Meier survival curves and log rank testing. Toxicity was scored using CTCAE.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      SRT of 192 lesions in 108 pts. was performed between 7/2009 - 5/2018. Median age was 63y (range 33-80). Driver mutations were: EGFR 41%, ALK 14%, other 21%, unknown/no 24%. Median FU was 18.7 (range 1-102) mo. 90% were ECOG 0-1. Median 1 (range 1-5) metastasis was treated. Targeted therapies were started before SRT in 69%, during SRT in 8%, and after SRT in 23%. 60% received an ALK- or EGFR-TKI, 31% PD-L1/PD-1 inhibitors, 8% bevacizumab. Oligoprogressive and oligopersistent pts showed improved OS compared to advanced metastatic disease (p = 0.008) (Fig.1). PFS was best in oligoprogressive patients; median 20.1 vs 7 and 4.4 mo. (p = 0.006). LC was median 21.0, 12.0 und 9.0mo: no sign. difference between groups. After 1y, 86%, 47% and 39% continued the same immuno- or targeted therapy as before SRT. Severe acute toxicity were observed in 7%, late toxicity in 4%.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      An excellent survival with limited toxicity was observed when definitive SRT to a limited number of metastases was combined with targeted- or immunotherapy in oligoprogressive and oligopersistent NSCLC patients. SRT of metastatic sites allowed continuation of targeted-, or immunotherapy in many patients. These observations need to be further evaluated in prospective trials.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      Matthias Guckenberger.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.


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