Jonathan Spicer: It’s more often than not micrometastatic disease
Jonathan Spicer, Medical Director of the McGill Thoracic Oncology Program, shared a post by Drew Moghanaki, Professor and Chief of Oncology Service at the UCLA Department of Radiation Oncology, on X/Twitter:
“Distant metastasis is the most lethal complication resulting from incomplete treatment of locoregional disease. Drew Moghanaki! Why? Well, it’s more often than not micrometastatic disease.
If there was only locoregional immunogenicity, the primary problem of distant disease is not altered by the addition of radiotherapy. We didn’t really know this for sure until now and that’s why this trial was so important! That said, there may be value here for the ~20% locoregional disease progression we see with neoadjuvant chemo-IO, which is the current standard of care (Ralph Weichselbaum) for this kind of disease.
Nasser Altorki and colleagues may have unlocked a low morbidity pathway to mitigating locoregional progression. Need to see patterns of recurrence that account for the PFS findings. Were the progressions in the durva plus radiotherapy arm more frequently distant versus systemic? This seems to be the only potential upside of this regimen and perhaps future investigation should focus on borderline resectable patients?
However, almost all recurrences were in PDL1<25% patients. Hard to imagine that radiotherapy as a treatment is the answer for this population and for now concurrent neoadjuvant chemo-IO seems like the most reasonable adjunct to surgery. Wonder what could come of Brendon Stiles and colleagues working to incorporate all three modalities prior to surgery?”
Quoting Drew Moghanaki’s post:
“Patrick Forde and Mariano Provencio, It wasn’t the home-run many were hoping for.”
