Headline: Does metastasis directed therapy (MDT) benefit all oligometastatic cancers or does histology call the shots?
The Study: EXTEND was a basket phase 2 trial that tested whether adding MDT (SBRT or metastasectomy) to standard therapy improved outcomes for oligometastatic cancer across several histologies. It included 334 evaluable patients with 1-5 mets who were randomized within histology specific baskets to standard therapy +/- MDT. In aggregate, PFS was significantly improved with the addition of MDT (HR 0.54, 95% CI 0.41-0.72). But, that benefit wasn’t universal. The pancreas, prostate, and “other” baskets saw improved PFS with MDT, but the breast and renal baskets did not. The latter cases are evolving, though, as we’ve seen that MDT may do a better job as a way to delay systemic therapy or a change in systemic therapy rather than enhancing front line systemic therapy.
TBL: In one of the largest oligometastatic trials to date, the benefits of MDT appear histology-specific and more advanced imaging and molecular testing could provide a roadmap for which tumors benefit from MDT and which do not. | Sherry, ASTRO 2025
The Study: EXTEND was a basket phase 2 trial that tested whether adding MDT (SBRT or metastasectomy) to standard therapy improved outcomes for oligometastatic cancer across several histologies. It included 334 evaluable patients with 1-5 mets who were randomized within histology specific baskets to standard therapy +/- MDT. In aggregate, PFS was significantly improved with the addition of MDT (HR 0.54, 95% CI 0.41-0.72). But, that benefit wasn’t universal. The pancreas, prostate, and “other” baskets saw improved PFS with MDT, but the breast and renal baskets did not. The latter cases are evolving, though, as we’ve seen that MDT may do a better job as a way to delay systemic therapy or a change in systemic therapy rather than enhancing front line systemic therapy.
TBL: In one of the largest oligometastatic trials to date, the benefits of MDT appear histology-specific and more advanced imaging and molecular testing could provide a roadmap for which tumors benefit from MDT and which do not. | Sherry, ASTRO 2025