Local ablative therapy plus systemic treatment versus systemic therapy alone in oligometastatic non-small cell lung cancer: a systematic review and meta-analysis of randomized trials
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Published on: May 8, 2018
Yaocan Xu1, Yingyun Liang2, Weiwei Gao1
1Department of Oncology, Guiping People's Hospital, Affiliated Guiping Hospital of Youjiang Medical College for Nationalities, 7 Renmin Road West, Guiping, P. R. China.
Background:
This study aimed to evaluate the role of adding local ablative therapy (LAT) to standard systemic therapy (SST) in patients with oligometastatic non-small cell lung cancer (NSCLC).
Methods:
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating LAT in oligometastatic NSCLC. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Pooled hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results:
Sixteen RCTs (1,343 patients) were included. LAT significantly improved PFS (HR 0.63, 95%CI 0.55-0.72) and OS (HR 0.68, 95%CI 0.58-0.81). In EGFR‑mutant patients, LAT improved PFS (HR 0.54, 95%CI 0.44-0.66) and OS (HR 0.52, 95%CI 0.40-0.67), with consistent benefits across mutation subtypes, TKI generations, and LAT timing. In chemotherapy and/or immunotherapy recipients, LAT improved PFS (HR 0.69, 95%CI 0.56-0.86) but not OS (HR 0.83, 95%CI 0.64-1.07). No benefit was seen with LAT added to immunotherapy alone (PFS: HR 0.86, 95% CI 0.66-1.13; OS: HR 0.87, 95%CI 0.55-1.36); however, in PD‑L1 ≥1% patients, LAT significantly improved PFS (HR 0.34, 95%CI 0.12-0.96). In the chemotherapy‑alone subgroup, LAT did not improve PFS (HR 0.49, 95%CI 0.23-1.06) or OS (HR 1.17, 95%CI 0.78-1.75), but significantly prolonged PFS in patients with ≤3 metastases (HR 0.34, 95%CI 0.21-0.57). By brain metastasis status, LAT improved PFS in patients without brain metastases (HR 0.54, 95%CI 0.37-0.78), with a trend toward OS benefit (HR 0.69, 95%CI 0.48-1.00), but not in those with asymptomatic/minimally symptomatic lesions (PFS: HR 0.67, 95%CI 0.43-1.07; OS: HR 0.89, 95%CI 0.60-1.32). LAT increased grade ≥3 AEs (RR 1.62, 95%CI 1.10-2.39) and pneumonitis (RR 6.28, 95%CI 2.02-19.35).
Conclusions:
Adding LAT to SST significantly improves survival in oligometastatic NSCLC, particularly in EGFR‑mutant patients receiving EGFR‑TKIs, in PD‑L1 ≥1% patients receiving immunotherapy, in those with ≤3 metastases receiving chemotherapy, and in patients without brain metastases. These findings support a biomarker‑ and burden‑stratified approach to integrating LAT.
