ATOM: A phase II study to assess efficacy of preemptive local ablative therapy to residual oligometastases of NSCLC after EGFR TKI.

Autor: Chan OSH; Hong Kong Integrated Oncology Centre, Hong Kong, China; Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. Electronic address: oscarcsh@yahoo.com., Lam KC; Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Li JYC; Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China., Choi FPT; Department of Nuclear Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China., Wong CYH; Department of Nuclear Medicine, Hong Kong Sanatorium & Hospital, Hong Kong, China., Chang ATY; Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong, China., Mo FKF; Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Wang K; Department of Radiology, Prince of Wales Hospital, Hong Kong, China., Yeung RMW; Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China., Mok TSK; Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Jazyk: angličtina
Zdroj: Lung cancer (Amsterdam, Netherlands) [Lung Cancer] 2020 Apr; Vol. 142, pp. 41-46. Date of Electronic Publication: 2020 Feb 11.
DOI: 10.1016/j.lungcan.2020.02.002
Abstrakt: Objectives: NSCLC patients harboring EGFR mutation invariably developed resistance to EGFR TKI. We postulated that oligoresidual disease (ORD) after initial TKI might harbor resistant clones. This study aimed to test if preemptive local ablative therapy (LAT) can improve progression free survival (PFS) or not compared to historic data.
Materials and Methods: Patients indicated for EGFR TKI who possessed ORD (≤ 4 PET-avid lesions) after an initial 3-month TKI therapy were enrolled. After screening PET-CT, eligible patients with PET-avid ORDs were treated by LAT, either by stereotactic ablative radiotherapy (SABR) or surgery per clinicians' discretion. TKI was continued after LAT until it was considered ineffective. PET-CT was repeated on the 3rd and 12th month post-LAT (or at progression) apart from regular imaging. Further LAT was allowed in oligoprogressive disease. Primary endpoint was PFS rate at one-year from enrollment. Overall survival (OS), PFS and treatment safety were secondary endpoints. A post hoc comparison with screen failure cohort was performed.
Results: Eighteen patients were enrolled from 2014-17. Recruitment was stopped before the planned number (34) due to slow accrual. Two were excluded due to consent withdrawal and significant protocol violation. Median follow up was 39.1 months. Among the 16 analyzed patients, the one-year PFS rate (i.e. 15 month post TKI) was 68.8 %. Median OS was 43.3 months. All LAT were done by SABR, and none experienced ≥ grade 3 SABR related toxicities. Compared with screen failure cohort (n = 48), pre-emptive LAT effectively reduced risk of progression (HR 0.41, p = 0.0097).
Conclusion: Preemptive LAT in ORD appeared to be safe and feasible. The 1-year PFS rate was encouraging. However, potential biases and the limitations of the study should not be overlooked. Further randomized studies are warranted.
Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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