WCLC 2025 | START-NEW-ERA #OLIGO: assessing SABR in oligo-progressive NSCLC

Yesterday I presented the clinical outcomes of the START-NEW-ERA #OLIGO trial. This is a trial in oligometastatic non-small cell lung cancer. We are all synchronous and metachronous oligometastatic non-small cell lung cancer, but yesterday we focused on oligoprogressive non-small cell lung cancer patients during immunotherapy and targeted therapy. Patients received the best treatment approach according to the stage of disease. At the moment of diagnosis of oligoprogression, they received stereotactic body radiation therapy to all oligoprogressive sites. We consider patients within five metastases, however, eight out of ten were accepted and primary tumor, regional nodes and brain metastases were not counted in the total number of metastases. Until now, we enrolled 90 patients, 67% during immunotherapy, 37% during targeted therapy. Most patients had one to three lesions apart from primary tumor and the original nodes. 55% of patients received stereotactic body radiation therapy to the primary tumor. The most common site of extrathoracic location was bone. After 28 months of follow-up we showed that the new systemic therapy-free survival, which is a primary endpoint of our trial, was met because it was 49 months and 49 months without difference by ongoing treatment, patients receiving immunotherapy or patients receiving targeted therapy. In terms of safety, the trial is met because only one patient had a grade 3 toxicity, a cell-related. In our opinion, our prospective phase 2 trial is important because we introduced the new strategic primary endpoint of new systemic therapy-free survival and we showed that in oligoprogressive non-small cell lung cancer, SBRT is the standard of care.

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