Top Line: Definitive chemoradiation followed by consolidative immune checkpoint inhibition is the standard for inoperable locally-advanced non-small cell lung cancer (NSCLC).
The Study: Where do we go from here? An important step to deciding where our efforts should focus is a thorough examination of patterns of failure with this approach. This was performed on 229 consecutive patients receiving treatment at U Penn for stage III NSCLC. At a median follow-up of 39 months, just over half (n=119) had disease progression with the majority (n=71) being isolated distant failure. Of the remaining 48 with locoregional failure, the majority was in-field (n=28). Interesting from a salvage therapy perspective is that half of all progressive disease (n=60) were eligible for ablative radiation two-thirds of these (n=40) received local therapy alone (sans salvage systemic therapy). In line with the current paradigm of oligometastatic disease, patients with “low-volume” disease progression (in ≤3 sites, n=64) had improved post-progression survival on multivariate analysis (HR 0.32) that was more than double that of their counterparts: 37 versus 15 months, respectively.
TBL: While the majority of disease progression following definitive chemoradiation and consolidative immune checkpoint inhibition for NSCLC is distant, roughly half of progressive disease are eligible for salvage ablative radiation to all sites in which case post-progression median survival exceeds 3 years. | Friedes, Int J Radiat Oncol Biol Phys 2023
The Study: Where do we go from here? An important step to deciding where our efforts should focus is a thorough examination of patterns of failure with this approach. This was performed on 229 consecutive patients receiving treatment at U Penn for stage III NSCLC. At a median follow-up of 39 months, just over half (n=119) had disease progression with the majority (n=71) being isolated distant failure. Of the remaining 48 with locoregional failure, the majority was in-field (n=28). Interesting from a salvage therapy perspective is that half of all progressive disease (n=60) were eligible for ablative radiation two-thirds of these (n=40) received local therapy alone (sans salvage systemic therapy). In line with the current paradigm of oligometastatic disease, patients with “low-volume” disease progression (in ≤3 sites, n=64) had improved post-progression survival on multivariate analysis (HR 0.32) that was more than double that of their counterparts: 37 versus 15 months, respectively.
TBL: While the majority of disease progression following definitive chemoradiation and consolidative immune checkpoint inhibition for NSCLC is distant, roughly half of progressive disease are eligible for salvage ablative radiation to all sites in which case post-progression median survival exceeds 3 years. | Friedes, Int J Radiat Oncol Biol Phys 2023