Progression-Free-Survival and Overall Survival beyond 5 years of non-small cell lung cancer patients with synchronous oligometastases treated in a prospective phase II trial (NCT 01282450)
Mené sur 39 patients atteints d'un cancer du poumon non à petites cellules de stade IV avec moins de 5 oligométastases synchrones au diagnostic (âge moyen : 62,1 ans), cet essai de phase II évalue, du point de vue de la survie sans progression et de la survie globale à 1, 2, 3, 5 et 6 ans, l'intérêt d'ajouter à une chimiothérapie systémique un traitement chirurgical ou une radiothérapie ciblant la tumeur primitive et les métastases distantes
Background : Two randomized studies demonstrated an increased progression-free survival (PFS) by adding a radical local treatment to systemic therapy in responding patients with oligometastatic non-small cell lung cancer (NSCLC), but long-term data are lacking. We updated the results of our previous phase II trial with a minimal follow-up exceeding 7 years. Methods : Prospective single-arm phase II trial. The main inclusion criteria were pathologically proven NSCLC stage IV with less than five metastases at primary diagnosis, amendable for radical local treatment (surgery or radiotherapy). No previous response to systemic treatment was needed. Results : Forty patients were enrolled, 39 of whom were evaluable (18 men, 21 women); mean age was 62.1 ± 9.2 years (range, 44-81). Twenty-nine (74%) had N2 or N3 disease; 17 (44%) brain, seven (18%) bone, and four (10%) adrenal gland metastases. Thirty-five (87%) had a single metastatic lesion. Thirty-seven (95%) of the patients received chemotherapy as part of their primary treatment. Median overall survival (OS) was 13.5 months (95% CI 7.6-19.4); 1-, 2-, 3-, 5-, 6- year OS was 56.4%, 23.3%,12.8%, 10.3%, 7.7 % and 5.1%, respectively. Median progression-free survival (PFS) was 12.1 months (95% CI 9.6-14.3); 1-, 2-, 3-, 5-, 6- year OS was 51.3%, 13.6%, %,12.8%, 7.7%, 7.7 % and 2.5%, respectively. Only three patients (7.7%) had a local recurrence. Conclusions : In patients who were not selected according to response to systemic treatment, the PFS at 5 years was 8 %. Entering patients in trials combining local therapy with novel systemic agents (e.g. immunotherapy) remains mandatory.