Adding local treatment extends survival in stage IV NSCLC

  • Uhlig J & al.
  • JAMA Netw Open
  • 2 Aug 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Patients with stage IV NSCLC may benefit from combining systemic therapy with surgical resection, external beam radiotherapy (EBRT), or thermal ablation (TA) of the primary tumor site.

Why this matters

  • Up to 55% of patients with NSCLC present with stage IV disease; growing evidence supports adding local treatment to systemic therapy for extended survival.

Study design

  • Researchers analyzed the health records of 34,887 patients with stage IV NSCLC (54.5% men; median age, 68 [interquartile range, 60-75] years).
  • They compared OS between the following treatment groups:
    • Surgical resection + systemic therapy (n=835);
    • EBRT/TA + systemic therapy (n=9539); and
    • Systemic therapy alone (n=24,513).
  • Funding: US Department of Defense.

Key results

  • Median follow-up was 39.4 (IQR, 26.6-56.0) months.
  • Adding surgical resection was associated with superior OS compared with add-on EBRT/TA (HR, 0.62; P<.001 systemic therapy alone p>
  • Adding EBRT/TA significantly improved OS vs systemic therapy alone (HR, 0.95; P=.002).
  • EBRT/TA survival benefit was more pronounced among patients with squamous cell NSCLC, T1-T2 N0-N1 disease, and oligometastases (HR, 0.68; P

Limitations

  • Retrospective design; lung function, specific systemic therapy protocols, targeted therapies, and exact tumor location/extent not captured.

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