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RT Plus Chemo Triples PFS In Limited Metastatic Lung Cancer.

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Consolidation treatment with stereotactic ablative radiotherapy (SAbR) prior to maintenance chemotherapy almost tripled progression-free survival (PFS) in patients with limited metastatic non–small cell lung cancer (NSCLC) compared to maintenance chemotherapy alone.

A new analysis showed that there was a statistically significant improvement in PFS from 3.5 to 9.7 months with the addition of consolidative radiotherapy to maintenance chemotherapy for patients with limited metastatic NSCLC (hazard ratio [HR], 0.304; 95% confidence interval [CI], 0.113 – 0.815; P = .01).

“There was a near tripling of PFS, and we hope and expect it will correlate with overall survival, but at the time of this analysis, median overall survival not yet been reached,” said Puneeth Iyengar, MD, PhD, lead author of the study and an assistant professor of radiation oncology at the University of Texas Southwestern Medical Center in Dallas.

Dr Iyengar presented the findings during the plenary session of the American Society for Radiation Oncology (ASTRO) 2018 Annual Meeting.

The study was also published online in JAMA Oncology to coincide with the meeting.

Dr Iyengar pointed out that previous studies in metastatic solid tumors and primary sites suggest a benefit of adding local therapy in the form of radiation or surgery to systemic therapy options for patients with limited metastatic NSCLC.

“We tried to identify a subset of patients who could potentially benefit from adding local therapy to maintenance systemic therapy for limited metastatic NSCLC,” he said

PFS and Local Control Improved

In this phase 2 study, Dr Iyengar and his colleagues evaluated the effect of SAbR on PFS in patients with limited metastatic NSCLC.

The cohort included 29 patients with stage IV NSCLC who had achieved a partial response or stable disease after induction chemotherapy and who had six or fewer sites of limited metastatic disease, including the primary site. The majority of patients (86%) had tumors with nonsquamous histologies.

Patients were randomly allocated to receive either maintenance chemotherapy alone (15 patients) or combination stereotactic body radiotherapy to all sites followed by maintenance chemotherapy (14 patients). Radiation to metastases was offered as a single fraction (to 21 – 27 Gy), three fractions (to 26.5 – 33 Gy) or five fractions (to 30 – 37.5 Gy).

For the primary tumor, radiation was delivered at total dose of 45 Gy when possible or by 15 fractions of hypofractionated radiotherapy if the primary tumor was centrally located or involved mediastinal nodes.

Chemotherapy choice was left to the discretion of the treating medical oncologists and consisted of pemetrexed, docetaxel, erlotinib, or gemcitabine.

The study’s primary endpoint was PFS; secondary endpoints included toxicity, local and distant tumor control, and patterns of failure.

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