The impact of switching systemic treatment after radiosurgery (SBRT) for oligo-progressive, metastatic renal cell carcinoma (mRCC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 599-599
Author(s):  
Pedro C. Barata ◽  
Rupesh Kotecha ◽  
Prateek Mendiratta ◽  
Aditya Juloori ◽  
Lilyana Angelov ◽  
...  
Keyword(s):  
Local Control ◽  
Systemic Therapy ◽  
Treatment Duration ◽  
Systemic Treatment ◽  
Spinal Metastases ◽  
Local Therapy ◽  
Current Therapy ◽  
Time Interval ◽  
Systemic Treatments ◽  
The Impact

599 Background: Local therapy such as SBRT is increasingly applied to RCC metastases when progression involves a limited number of metastatic sites (oligo-progression; O-PD). We aimed to assess the clinical outcome of patients (pts) with O-PD who changed systemic treatment upon SBRT (SWITCH) compared with those who remained on same therapy after SBRT (STAY); and also with the group of pts who progressed systemically (PD-SYS) and changed systemic treatment as well. Methods: Retrospective analysis of clear-cell mRCC pts treated with SBRT to brain or spinal metastases was undertaken. Clinical outcomes and treatment duration on current therapy of pts in the SWITCH, STAY and PD-SYS groups were compared. Treatment duration was defined as the time interval between SBRT and discontinuation of current systemic therapy for STAY group and discontinuation of first subsequent therapy in the SWITCH and PD-SYS groups. Results: A total of 100 pts with mRCC who had SBRT were identified, including 44 in STAY, 23 in SWITCH and 33 in PD-SYS. Median age was 58 yrs (range 36-79), 76% men, 66% ECOG PS 0-1, 60% IMDC intermediate risk. 61 pts received SBRT to brain and 40 pts to spine with 87% local control rate. Most common systemic treatments at time of SBRT included anti-VEGF (72%), mTOR (11%), PD-1 inhibitors (10%), other (7%). Median treatment duration for STAY was 5.2 months (95% CI, 3.5-6.9) compared with 5.0 months (95% CI, 4.3-5.7) for SWITCH (p = 0.549) and 2.6 months (95% CI, 1.5-3.7) for the PD-SYS group (p = 0.002, compared to all O-PD pts). Median OS was 24.2 months (95% CI, 8.7-39.7) and 27.1 (95% CI, 12.7-41.9) months for STAY and SWITCH groups, respectively (p = 0.461) and 8.5 months (95% CI, 2.1-14.9) in the PD-SYS group (p = 0.014, compared to all O-PD pts). Conclusions: SBRT for pts with mRCC in brain or spine was feasible with excellent local control. The decision to allow pts to remain on their current systemic therapy did not compromise treatment duration or survival. Pts with progressive disease outside SBRT-treated sites had a worse outcome.

Patient-reported use of marijuana and cannabinoid (CBD) oil in patients with renal cell carcinoma undergoing systemic therapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5084-5084
Author(s):  
Dena Battle ◽  
Cristiane Decat Bergerot ◽  
Pavlos Msaouel ◽  
Tian Zhang ◽  
Daniel J. George ◽  
...  
Keyword(s):  
Side Effects ◽  
Systemic Therapy ◽  
Treatment Duration ◽  
Online Survey ◽  
Self Report ◽  
Hormone Substitution ◽  
Systemic Treatments ◽  
Number Of Patients ◽  
Patient Reported ◽  
The Impact

5084 Background: The use of cannabis and cannabinoid related products has become increasingly common among cancer patients. We sought to gather independent data from online kidney cancer patient communities to assess frequency of use of marijuana and CBD-oil and estimate influence on treatment duration and side-effects. Methods: The KCCure online survey was performed between August 1, and September 30, 2019. Descriptive statistics were used to characterize patients who self-report using marijuana, their systemic treatments, and interactions with their oncologists. Results: Out of 1,136 patients responding, 411 patients were on systemic therapy with a median age of 57 years (28-86). Of the 441 patients with systemic therapy, 223 patients (54%) were male. There was no difference in gender distribution or race among patients who reported using or not using marijuana and or CBD oil. 93 patients (21%) reported using marijuana or CBD oil and 35 patients (8.5%) reported using both. Patients using marijuana and/or CBD oil had a median age of 55.7 +/- 1.1 years compared with patients not using (65.1 +/- 6.9 years). The median treatment duration was 23.9+/-2.4 months for patients using marijuana and/or CBD oil versus 26.4+/- 1.9 months for patients not using these supplements (p=0.437). Patients using marijuana and/or CBD oil were more likely to have bothersome side effects from therapy (p=0.001) and were less likely to talk to their doctor about their situation (p=0.044). The median NCCN distress score in patients using marijuana and/or CBD oil was 49.5+/-25.7 versus 51.4+/-24.0 (p n.s.). No correlation was seen with the use of steroids, anti-diarrhea drugs, anti-nausea-drugs, hormone substitution or other drugs used to manage side effects. Conclusions: Marijuana and/or CBD oil are used by a significant number of patients. No benefit/harm on treatment duration and use of concomitant drugs to control side effects and severity was seen. Patients using marijuana and/or CBD oil were more likely to report bothersome treatment related side effects and were more willing to report their side effects to their provider. As cannabinoids become more mainstream and legal in a number of states, more research is needed to better understand the impact these supplements may have on patients.

The impact of stereotactic radiotherapy to metastatic site on systemic treatment decision in oligometastatic breast cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12564-e12564 ◽  
Author(s):  
Ali Ayberk Besen ◽  
Huseyin Mertsoylu ◽  
Fatih Kose ◽  
Berna Yıldırım ◽  
Sedat Gozel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Triple Negative ◽  
Systemic Treatment ◽  
Local Therapy ◽  
Breast Cancer Patients ◽  
Oligometastatic Disease ◽  
The One ◽  
The Impact ◽  
Er Status

e12564 Background: Patients with oligometastatic disease achieve long-term survival with multimodality treatment strategies. However, little attention has been paid to the effect of adjusting systemic therapy after local therapy in clinical studies. The aim of this study was to investigate the effects of changing or continuing the same treatment regimen following local therapy on survival parameters. Methods: Out of 350 metastatic breast cancer patients, treated between 2012 and 2016, 43 patients (12%) with oligometastatic disease were included in our study. Oligometastasis was defined as < 5 metastatic sites in the same or different organs. Results: At a median follow-up of 32 months (7–53 months), 29 (67.4 %) patients had died. The one- and two-year overall survival (OS) rates were 95% and 78%, respectively, and the one- and two-year progression-free survival (PFS) rates were 77% and 51%, respectively. Following stereotactic body radiotherapy (SBRT) to oligometastatic sites, systemic treatment protocols were changed in 28 (65.1%) patients, while systemic treatment was continued unchanged in 15 (34.9%) patients. Changes to systemic treatment were significantly higher in patients with two organ metastases compared to patients with one organ metastasis ( p= 0.04). In the univariate analysis, estrogen receptor (ER) status and triple negative disease were significantly predictive of OS. The ER status and the number of metastatic organs were identified as significant predictors of PFS. In the multivariate analysis, only age emerged as a significant independent predictor of OS, while the number of initial organs involved and triple negative disease were significant factors for PFS. Conclusions: A hybrid treatment strategy is associated with higher survival rates in oligometastatic breast cancer patients. Post-SBRT systemic treatment change had no significant impact on OS and PFS in this study.

Postoperative Stereotactic Body Radiotherapy for Spinal Metastases and the Impact of Epidural Disease Grade

Neurosurgery ◽  
2019 ◽  
Vol 85 (6) ◽  
pp. E1111-E1118 ◽  
Author(s):  
Majed Alghamdi ◽  
Arjun Sahgal ◽  
Hany Soliman ◽  
Sten Myrehaug ◽  
Victor X D Yang ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Spinal Metastases ◽  
Retrospective Chart Review ◽  
Vertebral Compression Fractures ◽  
Low Grade ◽  
High Grade ◽  
Hardware Failure ◽  
Spinal Segments ◽  
The Impact

Abstract BACKGROUND Postoperative stereotactic body radiotherapy (pSBRT) is an emerging indication for spinal metastases (SM). OBJECTIVE To report our experience with pSBRT for SM. METHODS A retrospective chart review was performed for prospectively collected data of patients treated between September 2008 to December 2015 with pSBRT and followed with serial spinal MRIs every 2 to 3 mo until death or last follow-up. Univariate and multivariable analyses were performed to identify predictive factors. RESULTS A total of 83 spinal segments in 47 patients treated with a median dose of 24 Gy in 2 fractions were included, with mostly lung and breast primaries. A total of 59.3% had preoperative high-grade epidural disease (ED) and 39.7% were unstable. The 12-mo cumulative incidence of local failure was 17% for all segments, and 33.3%, 21.8%, and 0% in segments with postoperative high-grade, low-grade, and no ED, respectively. Downgrading preoperative ED was predictive of better local control (P = .03). The grade of postoperative ED was also predictive for local control (P < .0001), as was a longer interval between prior radiotherapy and pSBRT in those previously irradiated (P = .004). The 12-mo overall survival rate was 55%. One case of radiculopathy, 3 vertebral compression fractures, and no cases of myelopathy, hardware failure, or skin breakdown were observed. CONCLUSION pSBRT is an effective and safe treatment. The association between downgrading preoperative ED and better local control following pSBRT is confirmed and supports the concept of separation surgery.

An observational study of metastatic renal cell carcinoma patients prior to initiation of initial systemic therapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS4679-TPS4679
Author(s):  
Elizabeth R. Plimack ◽  
Cheryl Nemec ◽  
Paul Elson ◽  
Cristina Suarez ◽  
Tanya B Dorff ◽  
...  
Keyword(s):  
Disease Progression ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Local Therapy ◽  
Primary Objective ◽  
Rank Test ◽  
Treatment Benefit ◽  
Radiographic Disease ◽  
Treatment Naïve ◽  
Signed Rank Test

TPS4679 Background: The biology of metastatic RCC is extremely diverse, including a subpopulation of patients with indolent growth of metastases. Because of the acute and chronic toxicity and assumed non-curative nature of current systemic targeted therapy, a select subset of patients may be better served with initial surveillance. Such an approach may allow for deferral of systemic therapy to minimize overall treatment-related toxicity burden while maintaining treatment benefit. Methods: A prospective phase II trial is being conducted to characterize the clinical course of patients with mRCC who defer initial systemic treatment. Appropriate patients are selected by the treating physician based on an observed indolent growth pattern. As such, there is a 12 month window allowed between the first diagnosis of metastatic disease and study entry. Patients must be treatment-naïve, asymptomatic, with histologically confirmed mRCC and clinically-evident, measurable disease to be eligible. Radiographic assessment is performed at baseline, every 3 months for year 1, every 4 months for year 2, then every 6 months. The primary objective is to characterize the clinical outcome of patients on observation in terms of time to RECIST defined disease progression and time to initiation of systemic treatment. Secondary endpoints include measurement of disease-related symptoms and depression/anxiety using standardized questionnaires (FKSI-DRS and HADS), as well as correlative endpoints analyzing the immune response over time for which blood is being collected for immune assays (TH1/TH2 phenotype, Tregs). Pts remain on study until initiation of systemic therapy due to radiographic disease progression, development of disease-related symptoms, withdraw of consent or clinical change that renders the patient unacceptable for further observation. Local therapy (e.g. surgery, radiation) during the observation period is permitted. Currently, 29 patients have been accrued at 5 collaborating sites. The target accrual of 50 pts provides adequate power for the primary descriptive endpoint as well as 80% power to detect changes from baseline for the correlate endpoints based on a two-sided Wilcoxon signed rank test.

Treatment patterns and survival in patients with late-stage hepatocellular carcinoma in France: A retrospective database analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 288-288
Author(s):  
Jean-frederic Blanc ◽  
Caroline Laurendeau ◽  
Nadia Kelkouli ◽  
Philippe Mathurin
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Late Stage ◽  
Systemic Treatment ◽  
Best Supportive Care ◽  
Treatment Patterns ◽  
Stage Disease ◽  
Systemic Treatments ◽  
Icd 10

288 Background: The prognosis for patients with late-stage hepatocellular carcinoma (HCC) is poor, with only one systemic treatment option available for patients until 2017. Aim: To describe treatment patterns and survival of French patients following diagnosis of late-stage HCC (Barcelona Clinic Liver Cancer classification B, C or D), using a comprehensive nationwide claims database, SNDS. Methods: The SNDS database was searched from 1 January 2015 to 31 December 2017 for patients with a diagnosis of HCC (ICD-10: C220) and late-stage disease, defined by the identification of transcatheter arterial chemoembolization (TACE) or radioembolization (TARE), HCC systemic therapy and/or best supportive care (BSC). Patients were followed up for a maximum of 2 years. Results: 17,298 patients (mean age: 68.7 years (SD: 11.3), 82.6% male) were identified, with 72.4% diagnosed at late stage. During follow-up, 29.6% of patients were treated with TACE or TARE, and 27.1% received systematic therapy (sorafenib in 99.5% of cases). The median duration of systemic treatment was 7.9 (95% CI: 7.4-8.5) months. In 62.5% of cases, this treatment was discontinued at 12 months; this proportion fell to 40.3% when using mortality as a competitive risk. Survival since diagnosis of late stage HCC differed according to the type of first treatment received. Median overall survival was 23.7, 11.9, 7.4 and 1 month in patients initially receiving TACE, TARE, systemic therapy or no treatment, respectively. Conclusions: These results confirm the high clinical burden of late-stage HCC over this period and the need for second-line systemic treatments to improve patient outcomes.

scholarly journals Analyses of the Local Control of Pulmonary Oligometastases after Stereotactic Body Radiotherapy and the Impact of Local Control on Survival

2020 ◽  
Author(s):  
Takaya Yamamoto ◽  
Yuzuru Niibe ◽  
Masahiko Aoki ◽  
Takashi Shintani ◽  
Kazunari Yamada ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Treatment Time ◽  
Performance Status ◽  
Local Therapy ◽  
Cox Proportional Hazards Model ◽  
Local Failure ◽  
Tumour Diameter ◽  
Primary Origin ◽  
The Impact

Abstract Background: Successful local therapy for oligometastases may lead to longer survival. The purpose of this multicentre retrospective study was to investigate factors affecting the local control (LC) of pulmonary oligometastases treated by stereotactic body radiotherapy (SBRT) and to investigate the impact of LC on survival.Methods: The inclusion criteria included 1 to 5 metastases, the primary lesion and other extrathoracic metastases were controlled before SBRT, and the biological effective dose (BED10) of the SBRT was 75 Gy or more. The Cox proportional hazards model was used for analyses.Results: Data of 1378 patients with 1547 tumours from 68 institutions were analysed. The median follow-up period was 24.2 months. The one-year, 3-year and 5-year LC rates were 92.1%, 81.3% and 78.6%, respectively, and the 1-year, 3-year and 5-year overall survival rates were 90.1%, 60.3% and 45.5%, respectively. Multivariate analysis for LC showed that increased maximum tumour diameter (p=0.011), type A dose calculation algorithm (p=0.005), shorter overall treatment time of SBRT (p=0.035) and colorectal primary origin (p<0.001 excluding oesophagus origin) were significantly associated with a lower LC rate. In the survival analysis, local failure (p<0.001), worse performance status (1 vs. 0, p=0.013; 2–3 vs. 0, p<0.001), oesophageal primary origin (vs. colorectal origin, p=0.038), squamous cell carcinoma (vs. adenocarcinoma, p=0.006) and increased maximum tumour diameter (p<0.001) showed significant relationships with shorter survival.Conclusions: Several factors of oligometastases and SBRT affected LC. LC of pulmonary oligometastases by SBRT showed a significant survival benefit compared to patients with local failure.

scholarly journals Local therapy for oligometastatic esophageal squamous cell carcinoma: a prospective, randomized, Phase II clinical trial

2021 ◽  
Author(s):  
Qi Liu ◽  
Junqiang Chen ◽  
Baosheng Li ◽  
Jinjun Ye ◽  
Shihong Wei ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Phase Ii ◽  
Squamous Cell ◽  
Systemic Therapy ◽  
Local Therapy ◽  
Randomized Phase Ii ◽  
The Impact

For patients with oligometastatic esophageal squamous cell carcinoma, the efficacy of local therapy is still controversial because of patient selection and lack of adequate controls in most studies. Here the authors design the ESO-Shanghai 13 trial, a prospective, multicenter, randomized, Phase II trial, to assess the impact of combined local therapy and systemic therapy on progression and survival compared with systemic therapy alone for patients with four or less metastases. A total of 102 patients will be recruited over 3 years from approximately five centers and randomized in a 1:1 ratio to receive either systemic therapy alone or systemic therapy and local therapy, such as radiation, surgery and thermal ablation. The primary endpoint is progression-free survival. The secondary endpoints are overall survival, local control, toxicity and quality of life. Clinical trial registration: NCT03904927  (ClinicalTrials.gov)

scholarly journals Analyses of the Local Control of Pulmonary Oligometastases after Stereotactic Body Radiotherapy and the Impact of Local Control on Survival

2020 ◽  
Author(s):  
Takaya Yamamoto ◽  
Yuzuru Niibe ◽  
Masahiko Aoki ◽  
Takashi Shintani ◽  
Kazunari Yamada ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Treatment Time ◽  
Performance Status ◽  
Local Therapy ◽  
Cox Proportional Hazards Model ◽  
Local Failure ◽  
Tumour Diameter ◽  
Primary Origin ◽  
The Impact

Abstract Background: Successful local therapy for oligometastases may lead to longer survival. The purpose of this multicentre retrospective study was to investigate factors affecting the local control (LC) of pulmonary oligometastases treated by stereotactic body radiotherapy (SBRT) and to investigate the impact of LC on survival.Methods: The inclusion criteria included 1 to 5 metastases, the primary lesion and other extrathoracic metastases were controlled before SBRT, and the biological effective dose (BED10) of the SBRT was 75 Gy or more. The Cox proportional hazards model was used for analyses.Results: Data of 1378 patients with 1547 tumours from 68 institutions were analysed. The median follow-up period was 24.2 months. The one-year, 3-year and 5-year LC rates were 92.1%, 81.3% and 78.6%, respectively, and the 1-year, 3-year and 5-year overall survival rates were 90.1%, 60.3% and 45.5%, respectively. Multivariate analysis for LC showed that increased maximum tumour diameter (p=0.011), type A dose calculation algorithm (p=0.005), shorter overall treatment time of SBRT (p=0.035) and colorectal primary origin (p<0.001 excluding oesophagus origin) were significantly associated with a lower LC rate. In the survival analysis, local failure (p<0.001), worse performance status (1 vs. 0, p=0.013; 2–3 vs. 0, p<0.001), oesophageal primary origin (vs. colorectal origin, p=0.038), squamous cell carcinoma (vs. adenocarcinoma, p=0.006) and increased maximum tumour diameter (p<0.001) showed significant relationships with shorter survival.Conclusions: Several factors of oligometastases and SBRT affected LC. LC of pulmonary oligometastases by SBRT showed a significant survival benefit compared to patients with local failure.

Circulating cell free tumor DNA detection as a prognostic tool in advanced pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4130-4130
Author(s):  
Gehan Botrus ◽  
Pedro Luiz Serrano Uson Junior ◽  
Puneet Raman ◽  
Adrienne Kaufman ◽  
Heidi E. Kosiorek ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Systemic Treatment ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Genetic Alterations ◽  
Genomic Alterations ◽  
Systemic Treatments ◽  
Investigation Methods ◽  
The Impact ◽  
Tumor Dna

4130 Background: Circulating cell-free tumor DNA (ctDNA) genomic profiling is an emerging tool for pancreatic cancer. The impact of detected genomic alterations in tumor response to systemic treatments and outcomes is under investigation. Methods: Patients with advanced pancreatic cancer and ctDNA collected at time of initial diagnosis were retrospectively evaluated. Results of ctDNA analysis were correlated with patients’ demographics, systemic treatment response, progression-free survival (PFS) and overall survival (OS). Results: A total of 104 patients were included in the analysis. The mean age was 70.5 years (SD: 8.3), 50% were male, 37% with locally advanced disease and 63% with metastatic disease. Somatic alterations were detected in 84.6 % of the patients, no genetic alterations were detected in 15.4%, and were associated more with locally advanced pancreatic cancer as opposed to metastatic, p = 0.025. 60.6 % of the cohort had ≥ 2 genomic alterations detected. 28% were treated with FOLFIRINOX and 63% with gemcitabine plus nab-paclitaxel as first-line systemic treatment. Patients with any detectable genomic alterations when compared to patients with no detectable variant had worse median PFS (6.2 versus 15.3 months, p = 0.005) and patients with ≥ 2 detectable genomic alterations had worse median PFS (5.6 versus 11.0 months, p < 0.001) and worse median OS (11.5 versus 24.2 months, p = 0.001). KRAS was detected in 62.5% of the patients and was associated with PD to systemic treatments (80.4% vs 19.6%, p = 0.006), worse median PFS (5.8 versus 13.0 months, p < 0.001) and worse median OS (11.5 versus 26.3 months, p = 0.002). TP53 was detected in 60% of patients and was associated with worse median PFS (5.9 versus 10.9 months, p = 0.02) and worse median OS (13.5 versus 24.2 months, p = 0.001). CCND2 was detected in 14% of the patients and was associated with worse median PFS (3.6 versus 8.2 months, p = 0.004). Conclusions: Our study showed that initial detection of ctDNA may identify different genomic alterations that help predict disease outcomes, confirmation of these findings in larger studies are warranted.

Systemic therapy for patients with breast cancer and one to three brain metastases (BM).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1090-1090
Author(s):  
Zaid A Soomro ◽  
Omar Alhalabi ◽  
Ryan Sun ◽  
Aya Albittar ◽  
Limin Hsu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Brain Metastases ◽  
Survival Time ◽  
Systemic Therapy ◽  
Local Therapy ◽  
Extracranial Disease ◽  
The Impact ◽  
Extracranial Metastases

1090 Background: Despite advances in systemic therapies and improved overall survival of metastatic breast cancer (MBC) patients, the development of brain metastases (BMs) remains a challenging complication that affects quality of life and increases morbidity and mortality. Current clinical practice guidelines recommend local treatment of BMs without changing systemic therapy (CST) in patients with stable systemic disease. Methods: We retrospectively investigated the impact of CST (when applicable as per treating physician’s discretion) after diagnosis of the initial 1-3 BMs on the patient’s progression-free survival time (PFS), defined as time to death, to a second BMs or to extracranial metastases. All MBC patients with 1 to 3 BMs only (without extracranial disease) treated at our institution between 2002 and 2017 were identified. For each patient, full information on follow-up and administered therapies were mandatory for inclusion. Hazard ratios (HR) were calculated using the Cox proportional hazard model. We also computed the restricted mean survival time (RMST) up to 5 years of follow-up. Results: Among the 2645 patient with BM treated at our institution, 80 were included for analysis. In regards to primary BMs management in patients, 46 of 80 (57%) were treated by radiation therapy, 6 of 80 (7.5%) underwent surgical resection, and 28 of 80 (35%) were managed by a combination of surgery and radiation therapy. All patients had staging imaging documenting lack of extracranial metastases at the time of local therapy of BMs. Following the primary management of BM, we observed that providers changed systemic therapy in 32 of 80 (40%), defined as the CST group. CST included both initiation of therapy in 16 of 80 (20%) and switching of adjuvant therapy in 16 of 80 (20%). Median PFS among CST was 7.7 months vs. 7.2 months among no CST (HR = 0.855, 95% confidence interval (CI) 0.53-1.38, p = 0.52). 5-year RMST for the CST group was 16.6 months vs. 12.8 months in no CST group. The difference of 3.8 months (95% CI 4.3-11.8) was not statistically significant. Conclusions: Patients with 1-3 BMs without extracranial disease had a median PFS close to 7.5 months after local therapy. Consistent with current standard of care of maintaining the same systemic therapy approach upon developing isolated BMs, our findings did not demonstrate a significant difference in PFS between patients who experienced a change in systemic therapy compared to those who did not.

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