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First Trial Combining Immunotherapy and LAT for Oligometastatic NSCLC Yields Intriguing Results
A phase 2 trial of patients with oligometastatic non–small-cell lung cancer (NSCLC) found that the use of pembrolizumab after locally ablative therapy (LAT) was tied to significant improvements in progression-free survival (PFS).
Joshua Bauml, MD, Assistant Professor of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, spoke with Oncology Learning Network about what led to this research and the clinical significance of these findings.
What existing data led you and your co-investigators to conduct this research?
Oligometastatic NSCLC represents approximately 7% of all NSCLC. Emerging data have indicated that the use of LAT for such patients seems to improve outcomes, but there are no data to guide the use of systemic therapy after such treatments.
Given the hypothesized synergy between ablative treatments such as XRT and immunotherapy, we tried to give patients who had completed LAT immunotherapy using pembrolizumab.
Please briefly describe your study and its findings.
We enrolled 45 patients at our center who had oligometastatic NSCLC (defined as up to 4 sites of metastatic disease deemed amenable to ablative therapy) that had completed LAT.
Patients completed 6 months of pembrolizumab. If they had no evidence of progression and were tolerating therapy well, patients had the option to complete an additional 6 months of pembrolizumab.
The primary outcome was PFS, and we compared to a historical reference population with a median PFS of 6.6 months. We found that the PFS seen on our trial was 19.1 months.
What are the possible real-world applications of these findings in clinical practice?
Ours is the first trial to combine immunotherapy with LAT for oligometastatic disease.
Our results are intriguing, and merit confirmation in a randomized controlled trial comparing LAT to LAT followed by immunotherapy.
