Half of the patients were randomized to the experimental arm of LCT ¬¬-- radiation or surgical resection of all metastases, with or without chemotherapy; the other half received standard-of-care chemotherapy (no-LCT). Radiation or surgery was determined by a multidisciplinary team based on metastasis presentation, and all variations of both modalities were permissible.

"With this study, we wanted to be pragmatic and allow the breadth of treatments that are now available to patients in general practice," says Gomez.


The study was powered for a three month PFS benefit. The median PFS time was 11.9 months in the LCT arm, compared to 3.9 months in the no-LCT arm.

Seventeen patients in the no-LCT group crossed over to the LCT arm, 14 due to progression.

Overall, of the 28 patients that progressed (12 in the LCT and 16 in the no-LCT) seven had progression in the primary site; three in a known site of metastasis; seven in a different metastasis and 11 in a combination of sites. Because the study was stopped early, overall survival is not yet mature.

The significance of the PFS findings surprised the researchers, says Gomez.

"For some time, there's been a push from this patient population as well as a provider trend to treat with additional therapy," says Gomez. "These findings provide evidence and enthusiasm to offer aggressive local treatment and, with validation, could pave the way to treat tens of thousands of lung cancer patients with curative intent."

Further research will report on both overall survival and quality of life, and follow up studies are being designed to include immunotherapy, making future findings more applicable to the current treatment options available to patients.

Limitations of the research include the heterogeneity of the patient population and the overall small size of the study. The study also was not powered to detect an overall survival benefit, and crossover between arms may dilute this effect.

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The trial was funded, in part, by MD Anderson's Lung Cancer Moon Shots Program and its philanthropic Lung Cancer Priority Fund.

In addition to Gomez, MD Anderson's Stephen Swisher, M.D., professor and head of the Division of Surgery, and John Heymach, M.D., Ph.D., professor and chair of Thoracic/Head and Neck Medical Oncology, are both co-senior authors. Other MD Anderson study authors include: George R. Blumenschein, M.D., Don L. Gibbons, M.D., Ph.D., Anne S. Tsao, M.D., Jianjun Zhang, M.D., Ph.D., William N. William, M.D., all with Thoracic/Head and Neck Medical Oncology; Jack J. Lee, Ph.D., executive vice provost and Mike Hernandez, Biostatistics; Ritsuko Komaki, M.D., Radiation Oncology; and Jose A. Karam, M.D., Urology. Additional authors are: Ross Camidge, M.D., Ph.D., Robert Doebele, M.D., Ph.D., Laurie E. Gaspar, M.D., and Brian D. Kavanagh, M.D., all of University of Colorado School of Medicine; Alexander V. Louie, M.D., London Regional Cancer Program.

None of the authors have conflicts to declare.

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