Final Analysis of Consolidative Use of Radiotherapy to Block (CURB) Oligoprogression Trial - A Randomized Study of Stereotactic Body Radiotherapy for Oligoprogressive Metastatic Lung and Breast Cancers

Tsai, C. Jillian; Yang, J.T.; Guttmann, D.M.; Shaverdian, N.; Eng, J.; Yeh, R.; Girshman, J.; Das, J.; Gelblum, D.; Xu, A.J.; Namakydoust, A.; Iqbal, A.; Mann, J.M.; Preeshagul, I.; Hajj, C.; Gillespie, E.F.; Modi, S.; Dang, C.; Drullinsky, P.; Zhi, W.; LaPlant, Q.; Rimner, A.; Shin, J.Y.; Wu, A.J.; Ng, K.; Gucalp, A.; Khan, A.J.; Sanford, R.; Bromberg, J.; Seidman, A.D.; Traina, T.A.; Gomez, D.R.; Flynn, J.; Zhang, Z.; Patel, J.A.; Berger, M.; Reis-Filho, J.S.; Lee, N.Y.; Riaz, N.; Robson, M.E.; Rudin, C.M.; Powell, S.N.

doi:10.1016/j.ijrobp.2022.09.008

Cited by 25 publications

(21 citation statements)

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“…The in-field failure rate reported in our study is about 2.5%. The CURB trial reported no grade 4 to 5 toxicity, and our study outcomes also showed no grade 4 to 5 toxicity 14 . Biomarkers, such as circulating tumor cells ctDNA, can serve as potential tools to identify which subgroup of patients have a higher propensity for progression from an oligometastatic to a poly-metastatic phenotype in NSCLC.…”

Section: Discussionmentioning

confidence: 51%

“…There were no data reported on the continuation of maintenance systemic therapy in the CURB trial. There was also no difference in quality of life in the SBRT with systemic therapy compared with systemic therapy alone 10 . Our study also included patients for whom larger field recurrences occurred, and hypo-fractionated RT was more appropriate for safety than SBRT.…”

Section: Discussionmentioning

confidence: 90%

“…There was also no difference in quality of life in the SBRT with systemic therapy compared with systemic therapy alone. 10 Our study also included patients for whom larger field recurrences occurred, and hypo-fractionated RT was more appropriate for safety than SBRT. A systematic review of oligoprogressive prospective trials showed 3 other prospective single-arm studies in NSCLC showing meaningful PFS outcomes similar to our study.…”

Section: Discussionmentioning

confidence: 99%

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Bombarding Oligoprogression

Chou,

Lee,

Saetern

et al. 2024

American Journal of Clinical Oncology

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Objectives: This study aims to evaluate the efficacy and toxicity of radiotherapy (RT) to oligoprogressive metastatic non–small cell lung cancer (NSCLC). Methods: This is a retrospective analysis of 23 patients with metastatic NSCLC on maintenance systemic therapy, developed oligoprogression (1 to 5 sites), and all oligoprogressive sites amenable to and treated with RT. The primary endpoints included progression-free survival (PFS) and median time to start next-line therapy (MTT). Kaplan-Meier survival analysis and log-rank testing were performed using R-Studio software. Results: Twenty-three patients met the inclusion criteria. The median overall survival for the entire cohort was 31.3 months (interquartile range [IQR]: 17.86 to 45.4). The median event-free survival for the entire cohort was 8.3 months (IQR: 2.7 to 12). Patients with no prior radiation had longer median event-free survival of 11.9 months (IQR: 8.4 to 18.2) compared with patients with a history of prior radiation at 4.1 months (IQR: 2.7 to 12; P = 0.041). The local control rate for the treated lesions was 97.5%. At 12 months follow-up, 6 (43%) of 14 living patients maintained systemic therapy without initiating next-line therapy. The median PFS for the entire cohort was 8.4 months (IQR: 4.1 to 17.5). Patients who did not receive prior radiation had longer median PFS of 11.9 months (IQR: 8.4 to 18.2) compared with patients who received prior radiation 6.2 months (IQR: 2.7 to 8.5; P = 0.018). Two patients (9%) had grade 3 chronic toxicity related to RT and were medically managed. Conclusion: We identified that in patients with oligoprogressive metastatic NSCLC, targeted RT to all progressive sites yielded high LC and favorable rates of PFS and MTT.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Bombarding Oligoprogression

Chou,

Lee,

Saetern

et al. 2024

American Journal of Clinical Oncology

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“…4-8,16 Within oligoprogressive disease, using SABR MDT to ablate resistant clones driving growth of a limited number of lesions in the background of otherwise well-controlled disease can allow for continuation of a currently otherwise effective therapy and even prolong OS. 17,18…”

mentioning

confidence: 99%

“…[4][5][6][7][8]16 Within oligoprogressive disease, using SABR MDT to ablate resistant clones driving growth of a limited number of lesions in the background of otherwise well-controlled disease can allow for continuation of a currently otherwise effective therapy and even prolong OS. 17,18 Using SABR to delay initiation of systemic therapy is a more controversial use of MDT. The STOMP trial of oligometastatic castration-sensitive prostate cancer demonstrated that the use of MDT prolongs the time to initiation of androgen deprivation therapy from 13 months to 21 months.…”

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confidence: 99%

Metastasis-Directed Therapy: A Moving Target Advancing Progress Forward

Deek,

Tran,

Jabbour

2024

JCO

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Clinical experience of consolidative radiotherapy for localized metastatic non-small cell lung cancer who showed favorable tumor response after systemic treatment

Kim,

Hwang

et al. 2024

Discov Onc

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Background Our study has aimed to assess the effects of consolidative high-dose radiotherapy on clinical outcomes in patients with localized metastatic non-small cell lung cancer (NSCLC) who showed favorable tumor response after systemic treatment. Methods We retrospectively reviewed the medical records of 83 patients with localized metastatic NSCLC, who received systemic therapy followed by consolidative local radiotherapy at the Korea University Guro Hospital between March 2017 and June 2022. In the current study, we defined localized metastatic disease as the presence of one to three metastatic sites at the time of diagnosis. And patients who showed favorable tumor response after systemic treatment, including oligo-progressive disease at the thoracic site which was amenable to curative high-dose local radiotherapy, were included. The planned total dose and fraction size mainly depended on the location of lesions. Results The median follow-up time after consolidative radiotherapy was 16 months (range: 5–52 months). The overall 2-year progression-free survival rates were 81.4%. Of 83 patients, only four (4.3%), treated with intensity-modulated radiation therapy, showed an in-field local recurrence. Interestingly, only one patient experienced a local failure among the 20 patients who showed an oligo-progressive disease at the thoracic site on the tumor response evaluation after systemic treatment. Regarding treatment-related pulmonary toxicity, three patients with grade-3 and one patient with grade-4 radiation pneumonitis were presented. Conclusions If the disease is sufficiently controlled and localized by systemic therapy, local consolidative radiotherapy is thought to improves local control rates with acceptable treatment-related toxicities in patients with localized metastatic NSCLC, especially those with oligo-progressive disease.

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Final Analysis of Consolidative Use of Radiotherapy to Block (CURB) Oligoprogression Trial - A Randomized Study of Stereotactic Body Radiotherapy for Oligoprogressive Metastatic Lung and Breast Cancers

Cited by 25 publications

References 0 publications

Bombarding Oligoprogression

Bombarding Oligoprogression

Metastasis-Directed Therapy: A Moving Target Advancing Progress Forward

Clinical experience of consolidative radiotherapy for localized metastatic non-small cell lung cancer who showed favorable tumor response after systemic treatment

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