Joshua Bauml, MD, Talks Management of Oligometastic Lung Cancer

Dr Bauml discusses novel developments in the management of oligometastatic disease.

Transcript:

Joshua Bauml:  My name is Joshua Bauml. I'm an assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania.

I'm excited this year at the perspectives in Thoracic Oncology College Meeting to talk about oligometastatic disease. This is an emerging field, but a really important one. We historically divided up lung cancers, cancers in general, into metastatic incurable disease and localized, but potentially curable disease.

We know that it doesn't really divide up so neatly. There are groups of patients who have a limited spread of their cancer turned oligometastatic disease, and these patients may benefit from more aggressive treatments. We've historically known this and known the colorectal cancer, where patients who have isolated liver metastasis can be cured with hepatic resection.

First the question is, does this happen in lung cancer? It turns out yes, it does. There have been multiple trials to date that have evaluated the role of locally ablative therapy.

The largest randomized study specific to lung cancer was led by Dr. Gomez and his colleagues. In that study, they looked at patients who had received systemic therapy for four cycles and randomized them to either radiation or ablative therapy with systemic therapy or systemic therapy alone.

They found that the ablative therapy led to an improvement in progression-free and overall survival. This is very intriguing and has led some people to take this practice on.

At Penn we just recently completed a study looking at adding immunotherapy to this condition and so giving patients locally ablative therapy for oligometastatic disease, actually even before systemic therapy, jumping right in with the locally ablative therapy and then after that giving six months to a year of pembrolizumab, a PD-1 inhibitor.

In our study we were able to show that patients who received this regimen had a median progression-free survival of around 19 months, which is pretty remarkable for patients with metastatic lung cancer, especially when you consider that the majority of the patients in our study were PDL-1 negative.

This indicates that the combination with locally ablative therapy and immunotherapy may be a very exciting next step for these patients.

Of course, our study was a single-arm study and the study led by Dr. Gomez was a randomized phase II study. There are currently ongoing randomized phase III studies such as the LU002 study being led through the cooperative groups that will help to definitively address the role of locally ablative therapy.

Accrual to these studies is essential to help advance the science and help our patients.