Headed in the right direction.

Top Line: For those looking to ablate every oligomet in sight, it’s worth pausing to reflect that “other” primary cancers—outside the usual suspects of breast, prostate, lung, and colorectal—were few and far between in the landmark SABR-COMET trial.

The Study: Even so, in 2019, you kinda hate to treat any cancer that has cropped up a single met after a long disease-free interval with the old-school approach of chemo alone. Here’s a hypothesis-generating retrospective review of 186 patients who developed metastatic disease following definitive treatment for a localized head and neck squamous cell carcinoma (HNSCC) within the Memorial Sloan Kettering system. Of these, 30 received some form of local “metastasis-directed therapy” with surgery or radiation. Sure, the numbers are small, but tbh so are those of SABR-COMET and Gomez (we hear you ablater-haters). First of all, and unsurprisingly, those with a single met were more likely to be alive at 5 years than those with more (35% versus 4%, respectively). The bigger news comes with the multivariate analysis demonstrating met-directed therapy was associated with a significantly lower risk of death (HR 0.36). What’s more, median survival free from subsequent mets among these 30 patients was impressively over two years.

TBL: While we can’t say for sure that met-directed treatment prolongs life for patients with a recurrence of HNSCC at a single distant site, their prognosis is good enough that it at least makes sense to try while awaiting more definitive data. | Beckham, Br J Cancer 2019