More of the same.

If you’re doubtful a large phase 3 randomization is going to happen in the wake of the jaw-dropping Gomez data, here’s a NCDB analysis to further justify your hesitations to randomize a patient with oligometastatic non-small cell lung cancer (NSCLC) to no local therapy. We’ll start with the limitations: of nearly 35K patients with unqualified “stage IV” NSCLC recorded between 2010 and 2015, roughly a quarter underwent some form of radiation or thermal ablation and only 835 (2%) a surgical resection. Want to guess which groups did best in what order? Yep, on multivariate analysis of overall survival, the 2% healthy enough for surgery won out, followed by those getting other local therapy, and last was those getting systemic therapy only. TBL: Pertinent to emerging trends, among those deemed to have NSCLC oligomets in the NCDB, those receiving local therapy instead of chemo alone enjoyed 10-15% absolute overall survival advantages at 1, 2 and 3 years. Uhlig, JAMA Netw Open 2019


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