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Nicholas Peter Giustini
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P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P19.10 - Evaluation of Local Therapy for Oligoprogressive Disease in Metastatic NSCLC Patients on Immunotherapy (ID 3324)
00:00 - 00:00 | Presenting Author(s): Nicholas Peter Giustini
- Abstract
Introduction
The use of local ablative therapy to treat NSCLC with oligometastatic disease (metastatic disease present in a limited number of sites) and oligoprogressive disease (disease progression in a limited number of sites) has been explored in multiple small prospective and retrospective series. Both Gomez et al 2016 and Iyengar et al 2017 have shown the benefit of radiation therapy as consolidative therapy for oligometastatic disease treated with chemotherapy or targeted therapy. For oligoprogressive disease, numerous retrospective studies indicate a benefit with the use of local ablative therapies in patients receiving targeted therapy. More recently, Friedes et al 2020 investigated the use of radiation for oligoprogressive disease for patients largely receiving chemotherapy, showing a PFS from local therapy to progression of 7.9 months. These data suggest the utility of local ablative therapy both in the oligometastatic and oligoprogressive disease settings, however have limited focus on these strategies for patients receiving immunotherapy.
Given the demonstrated benefit of incorporating immunotherapy in first line treatment of metastatic NSCLC patients without driver mutations, an investigation of the use of local therapy (radiation or resection) for patients on immunotherapy with progression was undertaken. The treatment of oligoprogressive disease in this setting may promote more durable responses both by eliminating selected colonies of tumor cells that develop resistance through immune surveillance escape and possibly by the release of neoantigens with resultant off target abscopal effects.
Methods
This is a retrospective analysis of 40 patients with pathologically diagnosed metastatic NSCLC without driver mutations who were placed on chemoimmunotherapy or immunotherapy with 1st repeat imaging showing at least stable disease (SD) who then progressed. We compared mPFS in patients who received local therapy (for ≤3 sites of disease) versus a control group who switched therapy for progression of disease and evaluated post local therapy PFS, which was defined as time from endling local therapy for oligoprogressive disease until radiographic progression while maintaining on the same immunotherapy.
Results
Of 40 patients, 52.5% were male, 47.5% were female, median aged 69 years old (ranged 43-83), 80% White, 12.5% Black, 5% Asian, and 2.5% Latino. The mPFS was 40.7 months (n = 7, 95% CI 0-107.94) in the oligoprogressive group vs 7.6 months (n = 33, CI 4.65-10.55) in the control immunotherapy group (p = 0.046). Based on Cox regression for age (<70 vs ≥70, p = 0.452), ECOG (0/1 vs 2, p = 0.142), smoking history (no vs yes, p = 0.197), histology (nonsquamous vs squamous, p = 0.693), and line of therapy (1st vs 2+, p = 0.788), there were no significant interactions. The median post local therapy PFS was 6.1 months (n = 11 events, 95% CI 2.65-9.55).
Conclusion
Retrospectively, in selected patients on immunotherapy, the use of local therapy to treat oligoprogressive disease showed a mPFS benefit and a median post local therapy PFS of 6.1 months. While these data are limited by small numbers and the inherent bias of patients who progress with limited disease possibly having more indolent disease, these results do warrant further investigation.
