Local therapy combined with chemotherapy versus chemotherapy for postoperative oligometastatic non-small-cell lung cancer

A new proposal of simplified classification of non-small cell lung cancer oligometastases for easy applicability through systematic literature analysis and meta-analysis validation

INTRODUCTION

Oligometastasis (OM) exhibits wide range of prognosis, which necessitates appropriate classification for optimal therapeutic decision-making. Complementing the ESTRO-EORTC classification which lacked prognostic differentiation and was rather complex, we propose a new and simpler classification based on systematic literature analysis and meta-analysis validation.

METHOD

The databases were searched up to April 2024. Inclusion criteria were (1) ≥ 10 Non-small cell lung cancer OM patients, (2) local ablative treatment (LAT) versus control (systemic/supportive treatment), (3) reporting progression free survival (PFS) or overall survival (OS), respectively. A simpler classification was proposed through systematic reviews evaluating outcomes based on OM characteristics. According to this new classification, the LAT benefit and pooled 2-year OS and 1-year PFS percentiles were validated through meta-analysis.

RESULTS

In overall meta-analysis, LAT was correlated with enhanced 1-year PFS (odds ratio (OR):3.487, p < 0.001) and 2-year OS (OR:2.984, p < 0.001), respectively. According to simplified classification, LAT benefit of 1-year PFS was differentiated with ORs of 5.631 (p < 0.001), 3.484 (p < 0.001), and 1.702 (p = 0.067) for Synchronous (Syn), OPS (Oligopersistence), and OPR (Oligoprogression/recurrence) subgroups, respectively. Inter-subgroup comparisons showed significant differences as well. For 2-year OS, ORs of LAT benefit were 3.366 (p < 0.001), 3.355 (p < 0.001), and 1.821 (p = 0.127) in Syn, OPS, and OPR subgroups, respectively; LAT benefit was significant in Syn and OPS, but not significant in OPR. In pooled percentile comparison, 1-year pooled PFS was significantly lower in the OPR group than others, both in the LAT and control arms.

CONCLUSION

Based on a systematic literature analysis and meta-analysis validation, we developed a simpler three-step OM classification: Syn, OPS, and OPR. We would propose this new classification that is simpler and more applicable to clinical decisions than the currently available classification.

Role of local ablative treatment in oligometastatic non-small cell lung cancer: a meta-analysis

INTRODUCTION

This meta-analysis analyzed the oncologic role of local ablative treatment (LAT) in oligometastatic nonsmall cell lung cancer.

METHOD

Pubmed, MEDLINE, Embase, and Cochrane Library were searched until October, 2022. Studies comparing LAT with standard care (control) were included. Sensitivity analyses were performed including randomized controlled studies (RCTs). Subgroup analyses were performed according to specific categories and metastatic burden. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Considering the median OS and PFS from landmark studies, 2-year OS and 1-year PFS rates were used to calculate pooled odds ratios (ORs).

RESULTS

A total of 20 studies (four RCTs) encompassing 1750 patients were included. Surgery and radiotherapy (60 and 90% of studies) were mainly used as LATs. Pooled ORs of OS and PFS were 3.492 (95% CI:2.612-4.699, P <0.001) and 3.743 (95% CI: 2.586-5.419, P <0.001), favoring LAT, respectively. Sensitivity analyses, including RCTs showed ORs of 4.111 ( P <0.001) and 4.959 ( P =0.001) regarding OS and PFS, favoring LCT, respectively. Pooled 1-year and 2-year OS rates were 83.8 and 58.4% in LAT arms, whereas 64.4 and 31% in control arms; pooled 1-year and 2-year PFS rates were 64.6 and 32.8% in LAT arms, and 36.1 and 10% in control arms. In subgroup analyses, the pooled ORs were 3.981 ( P <0.001), 3.355 ( P <0.001), and 1.726 ( P =0.373) in synchronous, oligopersistence, and oligoprogression/recurrence subgroups, respectively. Regarding PFS comparison, pooled ORs were 5.631 ( P <0.001), 3.484 ( P <0.001), and 1.777 ( P =0.07), respectively. According to metastatic burden categories, pooled ORs favored LAT arms in both analyses including low-metastatic and high-metastatic burden subgroups.

CONCLUSION

The present study supports the role of LAT in treating nonsmall cell lung cancer oligometastasis. The oligoprogression/recurrence disease could have less LAT benefit than synchronous or oligopersistent disease.

Role of Local Treatment for Oligometastasis: A Comparability-Based Meta-Analysis

PURPOSE

We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method.

MATERIALS AND METHODS

Four databases including PubMed, MEDLINE, Embase, and Cochrane library were searched. Target studies are controlled trials comparing outcomes of LCT versus a control group. Primary endpoints are overall survival (OS) and progression-free survival (PFS).

RESULTS

A total of 54 studies involving 7,242 patients were included. Pooled analyses showed that the LCT arm could achieve improved OS with pooled odds ratio of 2.896 (95% confidence interval [CI], 2.377 to 3.528; p < 0.001). Regarding PFS, pooled analyses showed pooled odds ratio of 3.045 (95% CI, 2.356 to 3.937; p < 0.001) in favor of the LCT arm. In the subgroup analyses including the studies with reliable comparability (e.g. randomized studies or intentionally matched studies without significant favorable prognosticator in LCT arms), pooled odds ratio was 2.548 (95% CI, 1.808 to 3.591; p < 0.001) favoring the LCT arm regarding OS. Regarding PFS, pooled OR was 2.656 (95% CI, 1.713 to 4.120; p < 0.001) which also favored the LCT arm. Subgroup analyses limited to the randomized controlled trials (RCT) were also performed and pooled odds ratios on OS and PFS were 1.535 (95% CI, 1.082 to 2.177; p=0.016) and 1.668 (95% CI, 1.187 to 2.344; p=0.003). The rates of grade ≥ 3 complications related to LCT was mostly low (< 10%) and not significantly higher compared to the control arm.

CONCLUSION

Pooled analyses results of all included studies, selected studies with reliable comparability, and RCT's demonstrated the survival benefit of LCT. These consistent results suggest that LCT was beneficial to the patients with oligometastasis.

Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

We conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.

Radiofrequency Ablation with Continued EGFR Tyrosine Kinase Inhibitor Therapy Prolongs Disease Control in EGFR-Mutant Advanced Lung Cancers with Acquired Resistance to EGFR Tyrosine Kinase Inhibitors: Two Case Reports

Objective

Lung cancer remains the leading cause of malignant tumor-related death globally. There is mounting evidence that a large proportion of patients harboring epidermal growth factor receptor (EGFR) mutation and treated with EGFR TKI experience oligoprogressive disease. The optimal treatment strategy for these patients is undetermined. Thus, in this article, we report two cases of EGFR-mutant NSCLC patients with locally resistant lesions achieving disease control via combination therapy.

Patients and Methods

We present two cases of lung adenocarcinoma patients that developed oligoprogressive disease during TKI treatment. For further treatment, the patient then received radiofrequency ablation.

Results

Through follow-up observation, we found that the addition of radiofrequency ablation might provide the clinical benefit of these two NSCLC patients.

Conclusion

Our two cases provide a promising treatment for oligoprogressive disease during the first-line EGFR-TKI therapy.