Get up and Gomez.
Top Line: There’s no doubt by now your med onc colleagues are asking you to SABR every oligomet in sight.
The Study: We recently got the full deets on the SABR-COMET trial, and now we can get better acquainted with its cousin the Gomez trial. To be honest, we love the design of the Gomez trial for one big reason. It truly embodies the concept of aggressively treating oligometastatic cancer without being chained to 5 fractions of radiation or less. Why? Well, you know how the saying goes: when all you have is a SABR... Eligible patients had metastatic non-small cell lung cancer (NSCLC) with up to 3 sites of distant disease. They also had to not progress after at least 4 cycles of systemic therapy. They were then randomized to continue on maintenance systemic therapy or receive consolidative treatment to all sites of disease with surgery and/or (any) radiation. In fact, many patients received fractionated chemoradiation for primary and mediastinal disease. Importantly, patients who progressed in the maintenance arm were allowed to crossover and receive consolidation. We know median overall survival for patients randomized to consolidation was 41 months compared to 17 for maintenance therapy. So what’s new? Well longer-term outcomes for one. In multivariate analyses, both early (randomized) and late (cross-over) consolidative treatment was associated with improved survival. Not only was any progression prolonged from 4 to 14 months, time to development of new lesions was prolonged from 6 to 14 months.
Bottom Line: Low-volume metastatic NSCLC that passes the stress test of not progressing on initial systemic therapy deserves consolidative treatment, and that might include conventional treatment of the primary lung disease. | Gomez, J Clin Oncol 2019
The Study: We recently got the full deets on the SABR-COMET trial, and now we can get better acquainted with its cousin the Gomez trial. To be honest, we love the design of the Gomez trial for one big reason. It truly embodies the concept of aggressively treating oligometastatic cancer without being chained to 5 fractions of radiation or less. Why? Well, you know how the saying goes: when all you have is a SABR... Eligible patients had metastatic non-small cell lung cancer (NSCLC) with up to 3 sites of distant disease. They also had to not progress after at least 4 cycles of systemic therapy. They were then randomized to continue on maintenance systemic therapy or receive consolidative treatment to all sites of disease with surgery and/or (any) radiation. In fact, many patients received fractionated chemoradiation for primary and mediastinal disease. Importantly, patients who progressed in the maintenance arm were allowed to crossover and receive consolidation. We know median overall survival for patients randomized to consolidation was 41 months compared to 17 for maintenance therapy. So what’s new? Well longer-term outcomes for one. In multivariate analyses, both early (randomized) and late (cross-over) consolidative treatment was associated with improved survival. Not only was any progression prolonged from 4 to 14 months, time to development of new lesions was prolonged from 6 to 14 months.
Bottom Line: Low-volume metastatic NSCLC that passes the stress test of not progressing on initial systemic therapy deserves consolidative treatment, and that might include conventional treatment of the primary lung disease. | Gomez, J Clin Oncol 2019
Beautiful summary.
ReplyDeleteHere is the "poor mans" / hopelessly oversimplified breakdown of LCT:
-Treatment of lung primary: CCRT (n=6, 60-66 Gy), 45-60/15 (n=7), Surgery (n=3, one rec'd PORT), 70/10 (n=1), 67.5/27 (n=1).
-Treatment of all sites: Surgery (n=7, two rec'd PORT), CCRT to primary (n=6, one conventional RT alone), SBRT (n=13), moderate hypofractionation (n=11), SRS (n=7, one post-op), 30/10 (n=3).