The Study: If you were left unsatisfied with this concept last year, maybe we can win you over with the final overall survival analysis of this similarly-designed phase 2 trial. This one enrolled 49 patients—an early stopping point after clear separations in progression free survival times. All had non-small cell lung cancer with oligo (≤3 sites) metastatic disease that didn’t progress with standard upfront cytotoxic chemo or EGFR- / ALK-targeted therapies and were then randomized +/- to consolidative local surgery or radiation. And now, median overall survival times have matured to be nothing less than jaw dropping: 40 months with local consolidative therapy and 17 without. Fascinatingly, this was despite cross-over being allowed at time of first progression, with 50% of those in the observation arm progressing in a manner no longer amenable to consolidative therapy. What might the token antagonistic med onc at tumor board say? This may not apply in the era of checkpoint inhibitors.
Bottom Line: The job market for radiation oncologists likely just got a whole lot better. | Gomez, ASTRO 2018