Among the presentations at this year’s American Society of Clinical Oncology (ASCO) meeting, 2 studies of metastatic non–small cell lung cancer (NSCLC) have potential clinical implications today and also illustrate the challenge of using progression-free survival (PFS) as a primary study end point.
Gomez and colleagues1 evaluated the potential benefit of local consolidation therapy (LCT) with surgery or irradiation to resect or ablate areas of residual visible disease after 4 cycles of initial chemotherapy or 3 months of epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-inhibitor therapy (for EGFR mutation– or ALK rearrangement–positive NSCLC, respectively) for stage IV NSCLC without a malignant pleural effusion. Patients with up to 3 sites of residual disease after initial systemic therapy were randomized to either the standard treatment arm of maintenance systemic therapy or surveillance at the discretion of the treating physician with no LCT, or to the investigational arm of LCT with any combination of local therapies to any site, potentially including chemotherapy concurrent with irradiation of any areas of residual disease followed by maintenance systemic therapy or surveillance. The primary end point was PFS, and patients were permitted to cross over to the LCT arm at the time of progression.
Howard (Jack) West. Highlights of Recent Studies of Metastatic Non–Small Cell Lung Cancer. JAMA Oncol. 2017;3(2):159–160. doi:10.1001/jamaoncol.2016.3676