Multicenter retrospective study of multimodal treatment for NSCLC with oligometastatic disease at diagnosis

Synchronous oligometastatic non-small cell lung cancer (sOMD) is a hetergenous subgroup of stage IV disease. A retrospective study at 5 centers in Germany evaluated multimodal treatment for patients with sOMD (≤ 5 metastases in ≤ 3 organs) diagnosed between July 2015 and May 2020. Patients receiving systemic therapy alone were compared with patients receiving systemic therapy plus surgery and/or radiotherapy (patients treated with local therapy alone were excluded). Among 293 patients with a median follow-up of 33.5 months, 74% received multimodal therapy. Median progression-free survival (PFS) was 9.9 months, and was significantly longer with multimodal therapy than with systemic therapy alone (10.2 versus 8.4 months (p=0.02). Median overall survival (OS) was 26.4 months, and was numerically longer with multimodal therapy than with systemic therapy alone (31.1 versus 20.0 months). Among patients receiving local treatment, surgery was associated with longer PFS and OS than radiotherapy. Complete local treatment of all metastatic lesions was associated with improved OS compared with incomplete treatment (median 31.6 versus 16.3 months). A sequential approach, with systemic therapy followed by local ablative treatment, appeared to provide the greatest benefit. In multivariable analysis, omission of local therapy independently predicted worse PFS (HR 1.55) and OS (HR 1.52). Older age and poorer ECOG performance status were also independently associated with inferior outcomes. The authors conclude that multimodal therapy was associated with improved outcomes compared with systemic therapy alone in sOMD.