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Ritsuko Komaki-Cox
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SH01 - Highlight of the Previous Day (ID 98)
- Event: WCLC 2019
- Type: Highlight of the Previous Day Session
- Track:
- Presentations: 6
- Now Available
- Moderators:Isabelle Opitz, Ritsuko Komaki-Cox
- Coordinates: 9/09/2019, 11:00 - 12:30, San Francisco (2009)
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SH01.01 - Surgery (Now Available) (ID 3658)
11:00 - 12:30 | Presenting Author(s): Khaled Alkattan
- Abstract
- Presentation
Abstract
Section not applicable
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SH01.02 - Radiation (Now Available) (ID 3659)
11:00 - 12:30 | Presenting Author(s): Laurie Gaspar
- Abstract
- Presentation
Abstract not provided
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SH01.03 - Advanced Lung Cancer (Now Available) (ID 3660)
11:00 - 12:30 | Presenting Author(s): Digambar Behera
- Abstract
- Presentation
Abstract
Will submit as and when available.
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SH01.04 - Targeted Therapy (Now Available) (ID 3661)
11:00 - 12:30 | Presenting Author(s): Rosario Garcia Campelo
- Abstract
- Presentation
Abstract not provided
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SH01.05 - Mesothelioma (Now Available) (ID 3662)
11:00 - 12:30 | Presenting Author(s): Michele Carbone
- Abstract
- Presentation
Abstract not provided
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SH01.06 - Immunotherapy (Now Available) (ID 3855)
11:00 - 12:30 | Presenting Author(s): Margarita Majem
- Abstract
- Presentation
Abstract not provided
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IBS23 - Treatment of NSCLC OMD in Clinical Practice (Ticketed Session) (ID 54)
- Event: WCLC 2019
- Type: Interactive Breakfast Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/10/2019, 07:00 - 08:00, Toronto (1985)
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IBS23.01 - Radiotherapy of OMD in Daily Clinical Practice (Now Available) (ID 3385)
07:00 - 08:00 | Presenting Author(s): Ritsuko Komaki-Cox
- Abstract
- Presentation
Abstract
Non-Small Cell Lung Cancer (NSCLC) is the leading cause of cancer related death in the world.1 Analysis of patterns of failure after first-line systemic therapy for metastatic NSCLC suggest that most progression events, either within or outside the central nervous system (CNS), occur only at sites of disease known to exist at baseline, rather than in new sites.2 Once systemic treatment becomes more efficacious, for patients with limited numbers of metastases, ablation of those metastases may be advantageous in terms of cytoreduction or removal of dominant disease sites that may seed other sites in the future. Stage IV disease that is limited to only a small number of sites (“oligometastatic” disease (OMD)) may reflect a more indolent phenotype that could benefit from local ablative therapy (e.g. surgery or radiation) for consolidation, as suggested by some preclinical and translational analyses.3,4 Several retrospective and small prospective trials have suggested that local therapy may be beneficial for patients with stage IV NSCLC presenting with limited metastases .5-8
At MDACC, we have performed a randomized, phase II study (NCT01725165) to evaluate progression-free survival (PFS) after aggressive local consolidative therapy (LCT) versus maintenance therapy or observation for patients with stage IV NSCLC with ≤3 metastases remaining after front line systemic therapy. As secondary aims, we explored: (1) the safety and incidence of high-grade toxicity, (2) overall survival (OS), (3) patterns of failure and the effect of salvage therapy among patients who crossed over to the local consolidation group, (4) time to development of disease at new metastatic sites, and (5) predictors of PFS.
Findings of our randomized trial of aggressive LCT followed by standard maintenance therapy versus maintenance therapy alone for patients with oligometastatic NSCLC that did not progress after initial systemic therapy were as follows.10 We found that the PFS time for the standard (maintenance therapy) group was almost exactly as had been hypothesized from prior studies (3.9 months observed vs. 4 months hypothesized), whereas that of the experimental (LCT) group was substantially longer than predicted (11.9 months observed vs. 7 months hypothesized). Notably, our hypothesis was based on retrospective data in which sites of new disease versus sites of known disease could be followed more thoroughly for progression. In addition, time to the appearance of a new lesion was longer for patients in the LCT arm than for in the no-LCT arm (11.9 months vs. 5.7 months, p=0.0497), suggesting that the LCT could be altering the natural history of the disease2, either by limiting the potential for later spread or possibly by altering systemic anticancer immune responses to facilitate longer control of subclinical disease. Our trial used SBRT or surgery for local treatment for the oligometastasis. However more recent trial was done by consolidative radiotherapy for the limited oligometastatic NSCLC showing SBRT(SABR)
Prior to the maintenance chemotherapy improved PFG compared to maintenance chemotherapy alone.10
Common oligometastatic lesions we usually treat by radiotherapy are brain, bone, adrenal gland, lung, liver lymph node, mediastinum, pleura and muscle. Daily clinical practice, we need to use image guided radiotherapy with 4 D simulation. We should use SBRT or SABR to eliminate oligometasis without overlapping previously irradiated area and avoid critical organs.
Take home message: 1) We have enough evidence that treating oligometastasis by aggressive local treatment improved PFS and less appearance of new lesions.
2) Patients are able to tolerate local aggressive RT by SBRT (SABR).
3) Need to consider patients with oligometastases to be treated agressibly by SBRT (SABR).
4) Efficacy to improve OS by additional immunotherapy to the SBRT or SABR to the oligometastasis requires a prospective randomized studies in future.
References
1.Siegel RL, Miller KD, Jemal A, CA, Cancer J for Clinicians: Cancer Statistics 2019 Volume 69 (1): 1-84.
2.Rusthoven KE, Hammerman SF, Kavanagh BD, Birtwhistle MJ, Stares M, Camidge DR. Is there a role for consolidative stereotactic body radiation therapy following first-line systemic therapy for metastatic lung cancer? A patterns-of-failure analysis. Acta Oncol 2009; 48(4): 578-83.
3.Wong AC, Watson SP, Pitroda SP, et al. Clinical and molecular markers of long-term survival after oligometastasis-directed stereotactic body radiotherapy (SBRT). Cancer 2016.
4.Lussier YA, Xing HR, Salama JK, et al. MicroRNA expression characterizes oligometastasis(es). PLoS One 2011; 6(12): e28650.
5. Salama JK, Chmura SJ, Mehta N, et al. An initial report of a radiation dose-escalation trial in patients with one to five sites of metastatic disease. Clin Cancer Res 2008; 14(16): 5255-9.
6.Inoue T, Katoh N, Aoyama H, et al. Clinical outcomes of stereotactic brain and/or body radiotherapy for patients with oligometastatic lesions. Jpn J Clin Oncol 2010; 40(8): 788-94.
7.Pfannschmidt J, Dienemann H. Surgical treatment of oligometastatic non-small cell lung cancer. Lung Cancer 2010; 69(3): 251-8.
8. De Ruysscher D, Wanders R, van Baardwijk A, Dingermans AC, et al, Radiacal Treatment of Non Small Cell Lung cancer Patients with Synchronous Oligometastases: Long Term Results of a prospective Phase II trial (Nct01282450) Journal of Thoracic Oncology 2012 ;7(10) 1547-1555
9. Gomez DR, Blumenschein GR, Lee JJ, Hernandez M, Ye R, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Gibbons DL, Karam JA, Kavanagh BD, Tang C, Komaki R, Louie AV, Palma DA, Tsao AS, Sepesi B, William WN, Zhang J, Shi Q, Wang XS, Swisher SG, Heymach JV. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. e-Pub Vol 17,1672-1682, 10/2016. PMID: 27789196
10. Iyengar P, Wardak Z, Gerbrer D, et al :Consolidative Radiotherapy for Limited Metastatic Non-Small Cell Lung Cancer: A Phase 2 Randomized Clinical Trial.JAMA Oncology 4(1) 2018 ,1-8
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