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Patterns of Failure in Synchronous Metastatic Non-Small Cell Lung Cancer Without Driver Alterations According to
Woo Joong Rhee1, Sangjoon Park1, Jee Suk Chang1
1Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Background:
Patterns of failure (POFs) after first-line immune checkpoint inhibitor (ICI)-based therapy in patients with synchronous metastatic non-small cell lung cancer (NSCLC) without oncogenic driver alterations may guide the selection of candidates for local consolidative therapy (LCT).
Methods:
We retrospectively evaluated patients diagnosed with synchronous metastatic NSCLC between January 2017 and December 2023. Patients with oncogenic driver alterations, those who did not receive ICIs as first-line therapy, or those who lacked follow-up imaging were excluded. Patients were stratified into four groups according to the number of metastatic lesions: 1, 2, 3-5, and >5 lesions. POFs were classified as original site recurrence (OSR) or new site recurrence with or without OSR (NSR). Competing risk analyses were performed.
Results:
A total of 221 patients were analyzed, with a median follow-up of 28.1 months. Initial failure patterns did not differ significantly across lesion-number groups (p = 0.417). The 2-year cumulative incidence of OSR was not significantly different between the groups (p = 0.828). A trend toward a lower NSR was observed in patients with a single metastatic lesion (p = 0.063). Analysis of subsequent failures revealed a higher rate of NSR in the 1-lesion group than in the other groups (p = 0.043). No independent predictors of OSR were identified in multivariate analysis.
Conclusions:
In synchronous metastatic driver-negative NSCLC treated with first-line ICI-based therapy, both OSR and NSR were common and not clearly associated with metastatic burden, suggesting that lesion number alone may be insufficient for selecting candidates for LCT.
Insights
Patterns of failure in synchronous metastatic non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) were common. Metastatic burden did not clearly predict recurrence patterns, suggesting lesion number alone is insufficient for selecting patients for local consolidative therapy (LCT).
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).
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