Aggressive Local Therapies Improve Survival for Limited-metastatic NSCLC

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Local treatment may provide a survival benefit for patients with metastatic non-small cell lung cancer.
Local treatment may provide a survival benefit for patients with metastatic non-small cell lung cancer.

About 1 in 5 patients with stage IV non-small cell lung cancer (NSCLC) have genetic mutations that qualify them for 1 of a handful of emerging targeted therapies. The majority of patients with advanced NSCLC, however, still lack any effective treatment options to delay progression or prolong life.

In an educational presentation at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting, Puneeth Iyengar, MD, PhD, of University of Texas (UT) Southwestern Medical Center in Dallas, discussed the use of aggressive local therapy, including surgery, radiation, or radiofrequency ablation (RFA), to increase survival among patients with limited metastatic – or oligometastatic – NSCLC.

“We have started accumulating data over the last 2 decades from smaller trials or institutional experience that show if we add a local treatment to those limited areas where disease has spread, we seem to think that we may have the ability to increase patients' survival,” Dr Iyengar told Cancer Therapy Advisor.

One of the first types of local therapy to consider is surgery. Data from an analysis of the National Inpatient Sample published in Cancer showed a 5.8% average annual increase in resections of NSCLC metastases between 2000 and 2011.

Improvements in surgical techniques and minimally invasive approaches have likely contributed to this increase, as has a slowing of disease progression due to more effective chemotherapy and the introduction of targeted therapies. A subset of patients has been identified in which the members have only isolated metastasis, and these patients may have prolonged survival after undergoing surgery.

According to Dr Iyengar, data suggest that an ideal patient for surgery may be 1 who had only a small primary lung cancer at the time of diagnosis and now has 1 to 2 sites of metastases, in the other lung, for instance.

A combined approach using surgery with radiation could be used for a patient who has a small primary lung cancer that could be surgically removed, and 1 brain lesion that could be treated with surgery or gamma knife radiation.

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