Thoracic Radiotherapy Improves the Survival in Patients With EGFR-Mutated Oligo-Organ Metastatic Non–Small Cell Lung Cancer Treated With Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitors: A Multicenter, Randomized, Controlled, Phase III Trial

Author(s): Hongfu Sun, MD¹; Minghao Li, MD^1,2; Wei Huang, MD¹; Jian Zhang, MD³; Shihong Wei, MD⁴; Yongjing Yang, MD⁵; Zhongtang Wang, MD¹; Shucheng Ye, MD⁶; Heyi Gong, MD³; Yaowen Zhang, MD⁷; Jie Li, MD⁸; Haixia Song, MD⁴; Lifang Wang, MD³; Xiangming Chen, BS⁹; Haiqun Lin, MD¹⁰; Gaofeng Ding, MD¹¹; Hongwei Li, MS⁸; Anping Zheng, MD⁷; Xuezhen Ma, MD¹²; ShaoShui Chen, MD¹³; Liping Liu, MD¹⁴; Kaixian Zhang, MD¹⁵; Chengrui Fu, MD¹; Wenzhi Liu, MD¹⁶; Jing Wang, PhD⁸; Xiaqin Zhang, MS⁸; Tingting Liu, MS¹; Dan Han, MD¹; Qian Zhao, MD¹; Peipei Wu, MD¹⁴; Qianqian Yuan, MD¹⁵; LiJun Tian, MD¹³; Ping Zhang, MD⁸; Xueqin Wu, MD⁸; Fei Chen, MD⁸; Zicheng Zhang, MD¹⁶; Baosheng Li, MD¹.

Source: https://doi.org/10.1200/JCO.23.02075

Dr. Maen Hussein's Thoughts

Patients were treated with thoracic and extrathoracic radiation to oligometastatic sites and it seems to help with improving survival, something to consider especially with SBRT now. Do our radiation oncologists have additional input?

PURPOSE

This multicenter, randomized, phase III clinical trial (Northern Radiation Oncology Group of China-002) focused on patients with oligo-organ metastatic non–small cell lung cancer (NSCLC) who have epidermal growth factor receptor (EGFR) mutations. We aimed to investigate whether first-line concurrent thoracic radiotherapy (TRT) and EGFR-tyrosine kinase inhibitors (TKIs), compared with TKIs alone, could achieve better survival.

MATERIALS AND METHODS

The patients in the TKI plus TRT group received 60 Gy to primary lung tumor and positive regional lymph nodes. Radiotherapy for metastases to other sites was determined by clinicians. The primary end point was the progression-free survival (PFS). Secondary end points included overall survival (OS) and treatment-related adverse events (TRAEs). The first and second interim analyses were performed in March 2021 and March 2022.

RESULTS

Between April 14, 2016, and February 25, 2022, a total of 118 patients were enrolled. Compared with the TKI alone group, the TKI plus TRT group achieved significantly better PFS (hazard ratio [HR], 0.57; P = .004) and OS (HR, 0.62; P = .029). The median PFS was 10.6 months in the TKI alone group and 17.1 months in the TKI plus TRT group. The median OS was 26.2 months and 34.4 months in the TKI alone group and TKI plus TRT group, respectively. The TKI plus TRT group showed better local control but was associated with a higher incidence of severe TRAEs (11.9% v 5.1%).

CONCLUSION

For patients with EGFR-mutated oligo-organ metastatic NSCLC treated with first-line EGFR-TKIs, concurrent TRT improves the PFS and OS, and TRAEs are acceptable and tolerable.

Author Affiliations

¹Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China; ²Department of Radiotherapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; ³Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China; ⁴Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, China; ⁵Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China; ⁶Department of Radiation Oncology, Affiliated Hospital of Jining Medical University, Jining, China; ⁷Department of Radiation Oncology, Anyang Tumor Hospital, the Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Henan Medical Key Laboratory of Precise Prevention and Treatment of Esophageal Cancer, Anyang, China; ⁸Department of Radiation Oncology, Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/ Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China; ⁹Department of Clinical Oncology, Taian City Central Hospital, Taian, China; ¹⁰Department of Oncology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; ¹¹Department of Radiation Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China; ¹²Department of Oncology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China; ¹³Department of Radiation Oncology, Binzhou Medical University Hospital, Binzhou, China; ¹⁴Department of Oncology, Jining No.1 People’s Hospital, Jining, China; ¹⁵Department of Radiation Oncology, Tengzhou Central People’s Hospital, Tengzhou, China; ¹⁶Department of Radiation Oncology, Shenzhen Traditional Chinese Medicine Hospital, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.

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