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Impact of Immune Checkpoint Inhibitors and Local Radical Treatment on Survival Outcomes in Synchronous
Mandy Jongbloed1, Valentina Bartolomeo2,3,4, Martina Bortolot5
1Department of Pulmonary Diseases, GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
Introduction:
The impact of an immune checkpoint inhibitor (ICI)-based systemic treatment strategy with or without local radical treatment (LRT) on outcomes for patients with NSCLC and synchronous oligometastatic disease (sOMD) is unknown.
Methods:
Multicenter retrospective study including adequately staged patients, with sOMD NSCLC (maximum five metastases in three organs [European Organization for Research and Treatment of Cancer definition]) between January 1, 2015 and December 31, 2022, treated with a first-line ICI-based versus chemotherapy-only regimen. Primary end points were progression-free survival and overall survival (OS) for an ICI-based versus chemotherapy-only strategy. Subgroup analyses were performed for patients who were deemed candidates for LRT in the multidisciplinary meeting and those proceeding to LRT.
Results:
A total of 416 patients were included, treated with chemotherapy-ICI (n = 138) or chemotherapy-only (n = 278), 319 out of 416 were deemed candidates by multidisciplinary meetings for LRT, whereas 192 (60%) proceeded to LRT. The median OS was significantly longer in the chemotherapy-ICI compared with the chemotherapy-only group (33.6 versus 15.9 mo, hazard ratio [HR] = 0.5, 95% confidence interval [CI]: 0.4-0.7, p < 0.001), in the subgroups who were candidate for LRT (36.1 versus 17.2 mo, HR = 0.5, 95% CI: 0.4-0.7, p < 0.001) and those proceeding to LRT (not reached versus 23.1 mo, HR = 0.4, 95% CI: 0.2-0.7, p < 0.001). In multivariate analysis, an ICI-based strategy was associated with improved survival in the total group (HR = 0.6, 95% CI: 0.4-0.9, p < 0.001), in those with intention of LRT (HR = 0.6, 95% CI: 0.4-0.9, p = 0.02) and those who proceeded to LRT (HR = 0.3, 95% CI: 0.1-0.6, p = 0.002).
Conclusions:
An ICI-based systemic treatment strategy (±LRT) is associated with improved survival compared with chemotherapy-only (±LRT) for patients with sOMD NSCLC. Prospective randomized trial data are necessary to identify patients most likely to benefit from adding LRT.
Insights
Immune checkpoint inhibitor (ICI)-based treatment significantly improves survival for non-small cell lung cancer (NSCLC) patients with synchronous oligometastatic disease (sOMD). This strategy, with or without local radical treatment (LRT), offers better outcomes than chemotherapy alone.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Synchronous oligometastatic disease (sOMD) in non-small cell lung cancer (NSCLC) presents unique treatment challenges.
- The optimal systemic treatment strategy, particularly the role of immune checkpoint inhibitors (ICIs) combined with local radical treatment (LRT), remains incompletely understood.
Purpose of the Study:
- To evaluate the impact of ICI-based systemic treatment, with or without LRT, on patient outcomes in NSCLC with sOMD.
- To compare ICI-based strategies against chemotherapy-only regimens in this specific patient population.
Main Methods:
- A multicenter retrospective study included 416 NSCLC patients with sOMD (≤5 metastases in 3 organs).
- Patients received either first-line ICI-based therapy or chemotherapy-only.
- Outcomes were assessed based on progression-free survival and overall survival (OS), with subgroup analyses for LRT candidacy and receipt.
Main Results:
- ICI-based treatment significantly improved median OS compared to chemotherapy-only (33.6 vs. 15.9 months).
- This survival benefit was consistent in subgroups considered for LRT and those who proceeded with LRT.
- Multivariate analysis confirmed ICI-based strategy as an independent predictor of improved survival.
Conclusions:
- An ICI-based systemic treatment strategy, with or without LRT, demonstrates superior survival outcomes for NSCLC patients with sOMD compared to chemotherapy-only.
- Further prospective randomized trials are needed to precisely identify patient subgroups who would most benefit from the addition of LRT.
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