Patterns of Failure in Synchronous Metastatic Non-Small Cell Lung Cancer Without Driver Alterations According to...

Area of Science:

• Oncology
• Pulmonology
• Cancer Research

Background:

• Immune checkpoint inhibitors (ICIs) are a standard first-line therapy for synchronous metastatic non-small cell lung cancer (NSCLC) without driver alterations.
• Understanding patterns of failure (POFs) is crucial for optimizing treatment strategies, including the potential role of local consolidative therapy (LCT).

Purpose of the Study:

• To investigate the relationship between the number of metastatic lesions and patterns of failure (POFs) in patients with synchronous metastatic driver-negative NSCLC receiving first-line ICI-based therapy.
• To determine if metastatic burden influences the likelihood of original site recurrence (OSR) or new site recurrence (NSR).

Main Methods:

• Retrospective analysis of 221 patients with synchronous metastatic NSCLC treated with first-line ICIs.
• Patients were stratified into groups based on the number of metastatic lesions (1, 2, 3-5, >5).
• Competing risk analyses were used to evaluate POFs, including OSR and NSR.

Main Results:

• Initial POFs did not significantly differ across lesion-number groups.
• The 2-year cumulative incidence of OSR was similar across all groups.
• A trend towards lower NSR was observed in the single-lesion group, but subsequent failures showed a higher NSR rate in this group.
• Multivariate analysis identified no independent predictors of OSR.

Conclusions:

• Both original site recurrence (OSR) and new site recurrence (NSR) are common in synchronous metastatic driver-negative NSCLC treated with first-line ICI therapy.
• Metastatic burden, indicated by lesion number, does not appear to be a strong predictor of POFs.
• Lesion number alone may be insufficient for selecting candidates for local consolidative therapy (LCT).