Impact of Immune Checkpoint Inhibitors and Local Radical Treatment on Survival Outcomes in Synchronous Oligometastatic NSCLC

IF 3 Q2 ONCOLOGY

JTO Clinical and Research Reports Pub Date : 2025-01-08 DOI:10.1016/j.jtocrr.2025.100790

Mandy Jongbloed MD , Valentina Bartolomeo MD , Martina Bortolot MD , Shahan Darwesh MD , Jarno W.J. Huijs MD , Safiye Dursun MD , Juliette Degens MD, PhD , Ben E.E.M. van den Borne MD, PhD , Maggy Youssef-El Soud MD, PhD , Marcel Westenend MD, PhD , Cordula Pitz MD, PhD , Dirk K.M. De Ruysscher MD, PhD , Lizza E.L. Hendriks MD, PhD

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Abstract

Introduction

The impact of an immune checkpoint inhibitor (ICI)–based systemic treatment strategy with or without local radical treatment (LRT) on outcomes for patients with NSCLC and synchronous oligometastatic disease (sOMD) is unknown.

Methods

Multicenter retrospective study including adequately staged patients, with sOMD NSCLC (maximum five metastases in three organs [European Organization for Research and Treatment of Cancer definition]) between January 1, 2015 and December 31, 2022, treated with a first-line ICI-based versus chemotherapy-only regimen. Primary end points were progression-free survival and overall survival (OS) for an ICI-based versus chemotherapy-only strategy. Subgroup analyses were performed for patients who were deemed candidates for LRT in the multidisciplinary meeting and those proceeding to LRT.

Results

A total of 416 patients were included, treated with chemotherapy-ICI (n = 138) or chemotherapy-only (n = 278), 319 out of 416 were deemed candidates by multidisciplinary meetings for LRT, whereas 192 (60%) proceeded to LRT. The median OS was significantly longer in the chemotherapy-ICI compared with the chemotherapy-only group (33.6 versus 15.9 mo, hazard ratio [HR] = 0.5, 95% confidence interval [CI]: 0.4–0.7, p < 0.001), in the subgroups who were candidate for LRT (36.1 versus 17.2 mo, HR = 0.5, 95% CI: 0.4–0.7, p < 0.001) and those proceeding to LRT (not reached versus 23.1 mo, HR = 0.4, 95% CI: 0.2–0.7, p < 0.001). In multivariate analysis, an ICI-based strategy was associated with improved survival in the total group (HR = 0.6, 95% CI: 0.4–0.9, p < 0.001), in those with intention of LRT (HR = 0.6, 95% CI: 0.4–0.9, p = 0.02) and those who proceeded to LRT (HR = 0.3, 95% CI: 0.1–0.6, p = 0.002).

Conclusions

An ICI-based systemic treatment strategy (±LRT) is associated with improved survival compared with chemotherapy-only (±LRT) for patients with sOMD NSCLC. Prospective randomized trial data are necessary to identify patients most likely to benefit from adding LRT.

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