Using aggressive treatment after first line treatment for advanced non-small-cell lung cancer

The authors examined the use of local consolidative therapy to treat patients with advanced NSCLC with few metastases after first line treatment. They concluded that this is more effective than maintenance therapy alone for this specific group of patients.

Previous studies that examined treatment failure after first line treatment of advanced non-small-cell lung cancer (NSCLC) indicated that disease progression occurs at previously involved sites rather than new sites. It is possible, therefore, that patients with a small number of metastases (tumors that have spread) may benefit from aggressive local consolidative therapy. This refers to chemotherapy, radiotherapy or surgery after initial first-line treatment.  Currently most patients receive maintenance chemotherapy following initial treatment. This is a non-aggressive therapy that avoids or slows the cancers return. Whether local consolidative therapy with or without maintenance therapy is beneficial for patients with advanced NSCLC remains unknown.

The authors aimed to determine whether treating patients with aggressive consolidative therapy after initial first line therapy would be beneficial. 49 patients with stage IV NSCLC and less than 3 metastases were included in this study. Group 1 consisted of 25 patients who all received local consolidative therapy with or without maintenance therapy. Group 2 had 24 patients who received maintenance therapy alone. Average follow up was 12 months.

Time to disease progression was 11.93 months for group 1 and 3.9 months for group 2. 30 patients experienced disease progression: 13 from group 1 and 17 from group 2. 14 patients overall died during follow-up, 6 from group 1 and 8 from group 2.

There were no life-threatening adverse effects, or deaths due to adverse effects. 3 patients from group 2 switched to group 1 due to adverse effects. There were five severe adverse effects in group 1 including inflammation of the lining of the esophagus, anemia (low red blood cell count) and pneumothorax (air in the fluid separating the lung from the chest wall). There were two grade 3 adverse effects in group 2 (fatigue and anemia).

The authors concluded that treating patients with advanced NSCLC with fewer than 3 metastases with local consolidative therapy improved progression free survival compared to maintenance therapy alone.