Objective:

To evaluate the order of treatments for patients with synchronous oligometastatic NSCLC without actionable genetic alterations, emphasizing the clinical significance of treatment sequencing.

Key Findings:

• Median overall survival (OS) was 26 months for the upfront LRT cohort and 25 months for the upfront ICI cohort, indicating comparable long-term outcomes.
• Three-year OS rates were approximately 45% for both cohorts, suggesting effective treatment strategies.
• Median progression-free survival (PFS) was about 11 months in both cohorts, highlighting the need for ongoing monitoring.
• Favorable prognostic factors included good performance status, non-squamous histology, and high PD-L1 expression, which should guide treatment decisions.
• Patients with brain metastases had better outcomes than those with bone or other metastatic sites, reinforcing the need for tailored approaches.

Interpretation:

The study suggests that both upfront and delayed LRT combined with ICI can lead to meaningful long-term survival, but the optimal treatment sequence remains undetermined, emphasizing the importance of multidisciplinary decision-making.

Limitations:

• Retrospective design introduces selection bias and cohort imbalance, which may affect the reliability of the findings.
• Many patients may not proceed to planned local therapy due to progression or treatment toxicity, impacting treatment outcomes.
• Findings should not be interpreted as supporting a guideline change, as they reflect real-world practices rather than definitive conclusions.

Conclusion:

Flexibility in treatment sequencing, guided by individual patient and disease characteristics, can yield favorable outcomes, emphasizing the need for multidisciplinary decision-making and further research to determine optimal sequencing.

Sources:

• Lung Cancer