Should We Target Oligometastatic EGFR-Mutated NSCLC with Radiotherapy before Administering Targeted Systemic Therapy?
Mené entre 2016 et 2019 sur 133 patients atteints d'un cancer du poumon non à petites cellules oligométastatique et présentant une mutation de l'EGFR (durée médiane de suivi : 23,6 mois), cet essai randomisé de phase III évalue l'intérêt, du point de vue de la survie sans progression, d'ajouter une radiothérapie à un traitement systémique par inhibiteur de la tyrosine kinase
In this issue of the Journal, Wang et al. report results of the SINDAS trial, randomizing patients with previously untreated EGFR-mutated non-small cell lung cancer (NSCLC), with 1-5 oligometastases, to receive first-generation tyrosine-kinase inhibitors (TKI) alone versus TKI following upfront radiotherapy to the primary tumor, involved regional nodes, and all oligometastases. Compared to TKI alone, upfront radiotherapy followed by TKI was associated with statistically significant, clinically meaningful benefits in progression-free survival (PFS) and overall survival (OS). The Phase III SINDAS trial joins a growing list of randomized Phase II studies investigating the addition of metastasis-directed therapy to standard systemic therapy for oligometastatic disease, showing benefits in PFS, and (in 2 studies) OS. We commend and congratulate the authors for this landmark work.
Journal of the National Cancer Institute , éditorial en libre accès, 2021