Stereotactic radiotherapy for oligoprogressive ER-positive breast cancer (AVATAR)

Alomran, Reem; White, Michelle; Bruce, Melissa; Bressel, Mathias; Roache, Susan; Karroum, Lama; Hanna, Gerard G.; Goel, Shom; David, Steven

doi:10.1186/s12885-021-08042-w

Cited by 14 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TTCST endpoint was collected in addition to PFS, as salvage SBRT can often be delivered in an attempt to prolong time on first-line agents as second- and third-line therapies are often less effective ( 24 ). Moreover, this endpoint is being used in current ongoing prospective studies on the role of local therapy in OMD as it can represent the timing of polymetastatic progression in which, to date, there is no role for ablative radiotherapy ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

Tsur,

Blumenfeld,

Rottenberg

et al. 2024

Transl Lung Cancer Res

View full text Add to dashboard Cite

Background Stereotactic body radiation therapy (SBRT) is often delivered in patients with oligometastatic disease (OMD). However, the specific subset of patients with polymetastatic non-small cell lung cancer (NSCLC) on novel systemic therapies who develop induced oligopersistant disease (OpersisD) or oligoprogressive disease (OprogD), as defined by the European Organisation for Research and Treatment of Cancer (EORTC) OMD classification, has not been well described. This study explores the outcomes of patients treated with this strategy. Methods Patients with stage IV NSCLC being treated with osimertinib or immune checkpoint inhibitors (ICIs) who received extracranial SBRT for OpersisD or OprogD were identified in our retrospective analysis. Outcomes reported include progression-free survival (PFS), time to change of systemic treatment (TTCST), overall survival (OS), local control (LC) and treatment-related toxicity. Results Forty-nine patients received SBRT for OpersisD (34.7%) or OprogD (65.3%) at a median of 5.8 and 15.3 months after start of systemic therapy, respectively. 55.1% received concurrent osimertinib and 44.9% received ICI. Seventy-seven extracranial lesions were treated with various fractionation schemas. At a median of 18.8 months follow-up from first SBRT, LC was achieved in 92.2% of total lesions treated (71). The 1-year OS was 91.7% for OpersisD and 83.3% for OprogD. OpersisD compared to OprogD had a longer median PFS (18.3 vs. 6.1 months) and longer median TTCST (23.6 vs. 13.5 months), median OS was not reached for either cohort. On multivariate analysis, patients treated with osimertinib had shorter PFS (HR: 2.20; 95% CI: 1.01–4.82; P=0.048) and shorter TTCST (HR: 2.83; 95% CI: 1.09–7.33; P=0.032). One patient (2%) experienced grade 3 pneumonitis after SBRT, and no grade 4–5 toxicities were reported with SBRT treatment. Conclusions This study indicates that SBRT for OpersisD or OprogD in Stage IV NSCLC patients on osimertinib or ICIs is safe, very well tolerated, and may prolong the time before needing a shift in systemic therapy. Further prospective research is needed to validate and expand upon these findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

Tsur,

Blumenfeld,

Rottenberg

et al. 2024

Transl Lung Cancer Res

View full text Add to dashboard Cite

show abstract

“…Both the number of metastases and organs affected appear to have an impact on progression-free survival [ 37 ]. The growing interest in the treatment concept of oligometastatic disease has led to numerous studies, which will provide their results in the coming years [ 38 , 39 ]. Nevertheless, the detection of the oligometastatic stage remains the key challenge.…”

Section: Discussionmentioning

confidence: 99%

Gastrin-Releasing Peptide Receptor Antagonist [68Ga]RM2 PET/CT for Staging of Pre-Treated, Metastasized Breast Cancer

Michalski

Kemna

Asberger

et al. 2021

Cancers

View full text Add to dashboard Cite

Background: Positron emission tomography (PET)/computed tomography (CT) using the gastrin-releasing peptide receptor antagonist [68Ga]RM2 has shown to be a promising imaging method for primary breast cancer (BC) with positive estrogen receptor (ER) status. This study assessed tumor visualization by [68Ga]RM2 PET/CT in patients with pre-treated ER-positive BC and suspected metastases. Methods: This retrospective pilot study included eight female patients with initial ER-positive, pre-treated BC who underwent [68Ga]RM2 PET/CT. Most of these patients (seven out of eight; 88%) were still being treated with or had received endocrine therapy. [68Ga]RM2 PET/CTs were visually analyzed by two nuclear medicine specialists in consensus. Tumor manifestations were rated qualitatively (i.e., RM2-positive or RM2-negative) and quantitatively using the maximum standardized uptake value (SUVmax). SUVmax values were compared between the two subgroups (RM2-positive vs. RM2-negative). Results: Strong RM2 binding was found in all metastatic lesions of six patients (75%), whereas tracer uptake in all metastases of two patients (25%) was rated negative. Mean SUVmax of RM2-positive metastases with the highest SUVmax per patient (in lymph node and bone metastases; 15.8 ± 15.1 range: 3.7–47.8) was higher than mean SUVmax of the RM2-negative metastases with the highest SUVmax per patient (in bone metastases; 1.6 ± 0.1, range 1.5–1.7). Conclusions: Our data suggest that RM2 binding is maintained in the majority of patients with advanced disease stage of pre-treated ER-positive BC. Thus, [68Ga]RM2 PET/CT could support treatment decision in these patients, radiotherapy planning in oligometastatic patients or selection of patients for RM2 radioligand therapy. Further studies with larger patient cohorts are warranted to confirm these findings.

show abstract

“…Interestingly, there are also few trials on oligoprogressive breast cancer. The AVATAR trial (NCT04530513) is a phase II trial of patients with up to five oligoprogressive sites during treatment with endocrine therapy and a CDK4/6 inhibitor [ 50 ]. All patients will receive local ablative radiotherapy to the progressing lesions.…”

Section: Methodsmentioning

confidence: 99%

Oligometastasis in breast cancer—current status and treatment options from a radiation oncology perspective

et al. 2022

View full text Add to dashboard Cite

Evidence from a few small randomized trials and retrospective cohorts mostly including various tumor entities indicates a prolongation of disease free survival (DFS) and overall survival (OS) from local ablative therapies in oligometastatic disease (OMD). However, it is still unclear which patients benefit most from this approach. We give an overview of the several aspects of stereotactic body radiotherapy (SBRT) in extracranial OMD in breast cancer from a radiation oncology perspective. A PubMed search referring to this was conducted. An attempt was made to relate the therapeutic efficacy of SBRT to various prognostic factors. Data from approximately 500 breast cancer patients treated with SBRT for OMD in mostly in small cohort studies have been published, consistently indicating high local tumor control rates and favorable progression-free (PFS) and overall survival (OS). Predictors for a good prognosis after SBRT are favorable biological subtype (hormone receptor positive, HER2 negative), solitary metastasis, bone-only metastasis, and long metastasis-free interval. However, definitive proof that SBRT in OMD breast cancer prolongs DFS or OS is lacking, since, with the exception of one small randomized trial (n = 22 in the SBRT arm), none of the cohort studies had an adequate control group. Further studies are needed to prove the benefit of SBRT in OMD breast cancer and to define adequate selection criteria. Currently, the use of local ablative SBRT should always be discussed in a multidisciplinary tumor board.

show abstract

Stereotactic radiotherapy for oligoprogressive ER-positive breast cancer (AVATAR)

Cited by 14 publications

References 32 publications

Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

Outcomes of extracranial stereotactic body radiation therapy for induced oligometastatic non-small cell lung cancer on novel systemic therapy

Gastrin-Releasing Peptide Receptor Antagonist [68Ga]RM2 PET/CT for Staging of Pre-Treated, Metastasized Breast Cancer

Oligometastasis in breast cancer—current status and treatment options from a radiation oncology perspective

Contact Info

Product

Resources

About