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      Successful treatment of induced oligometastasis and repeated oligoprogression of advanced lung adenocarcinoma with immunotherapy and radiotherapy

      case-report

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          Abstract

          Highly active and durable systemic therapies such as targeted therapy and immunotherapy can convert widespread metastatic disease into oligometastatic status, for which metastasis‐directed local intervention can control and potentially prolong survival. Radiation therapy is an effective therapeutic option for oligometastatic and oligoprogressive disease. Here, we present a case of induced oligometastasis and repeated oligoprogressive lung cancer in which more than 6 years of survival was achieved with a combination of immunotherapy and radiotherapy.

          Abstract

          The time line for the clinical course of the patient from diagnosis to last follow‐up with radiographic images

          • Metastasis‐directed local intervention can control and potentially prolong survival.

          • Radiation therapy is the effective therapeutic option for oligometastatic and oligoprogressive disease.

          • Here we present a case of induced oligometastasis and repeated oligoprogressive lung cancer in which more than 6 years of survival was achieved with a combination of immunotherapy and radiotherapy.

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          Most cited references5

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          Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer.

          Background Most patients with locally advanced, unresectable, non-small-cell lung cancer (NSCLC) have disease progression despite definitive chemoradiotherapy (chemotherapy plus concurrent radiation therapy). This phase 3 study compared the anti-programmed death ligand 1 antibody durvalumab as consolidation therapy with placebo in patients with stage III NSCLC who did not have disease progression after two or more cycles of platinum-based chemoradiotherapy. Methods We randomly assigned patients, in a 2:1 ratio, to receive durvalumab (at a dose of 10 mg per kilogram of body weight intravenously) or placebo every 2 weeks for up to 12 months. The study drug was administered 1 to 42 days after the patients had received chemoradiotherapy. The coprimary end points were progression-free survival (as assessed by means of blinded independent central review) and overall survival (unplanned for the interim analysis). Secondary end points included 12-month and 18-month progression-free survival rates, the objective response rate, the duration of response, the time to death or distant metastasis, and safety. Results Of 713 patients who underwent randomization, 709 received consolidation therapy (473 received durvalumab and 236 received placebo). The median progression-free survival from randomization was 16.8 months (95% confidence interval [CI], 13.0 to 18.1) with durvalumab versus 5.6 months (95% CI, 4.6 to 7.8) with placebo (stratified hazard ratio for disease progression or death, 0.52; 95% CI, 0.42 to 0.65; P<0.001); the 12-month progression-free survival rate was 55.9% versus 35.3%, and the 18-month progression-free survival rate was 44.2% versus 27.0%. The response rate was higher with durvalumab than with placebo (28.4% vs. 16.0%; P<0.001), and the median duration of response was longer (72.8% vs. 46.8% of the patients had an ongoing response at 18 months). The median time to death or distant metastasis was longer with durvalumab than with placebo (23.2 months vs. 14.6 months; P<0.001). Grade 3 or 4 adverse events occurred in 29.9% of the patients who received durvalumab and 26.1% of those who received placebo; the most common adverse event of grade 3 or 4 was pneumonia (4.4% and 3.8%, respectively). A total of 15.4% of patients in the durvalumab group and 9.8% of those in the placebo group discontinued the study drug because of adverse events. Conclusions Progression-free survival was significantly longer with durvalumab than with placebo. The secondary end points also favored durvalumab, and safety was similar between the groups. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).
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            Combination of immunotherapy with chemotherapy and radiotherapy in lung cancer: is this the beginning of the end for cancer?

            Immune checkpoint inhibitors have significantly improved overall survival with an acceptable safety profile in a substantial proportion of non-small cell lung cancer (NSCLC) patients. However, not all patients are sensitive to immune checkpoint blockade and, in some cases, programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors accelerate tumor progression. Several combination strategies are under evaluation, including the concomitant or sequential evaluation of chemotherapy or radiotherapy with immunotherapy. The current review provides an overview on the molecular rationale for the investigation of combinatorial approaches with chemotherapy or radiotherapy. Moreover, the results of completed clinical studies will be reported.
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              Integration of radiotherapy and immunotherapy for treatment of oligometastases

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                Author and article information

                Contributors
                goodoc@gmail.com
                Journal
                Thorac Cancer
                Thorac Cancer
                10.1111/(ISSN)1759-7714
                TCA
                Thoracic Cancer
                John Wiley & Sons Australia, Ltd (Melbourne )
                1759-7706
                1759-7714
                22 May 2022
                July 2022
                : 13
                : 13 ( doiID: 10.1111/tca.v13.13 )
                : 1998-2000
                Affiliations
                [ 1 ] Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine Inje University Busan Paik Hospital, College of Medicine Busan Republic of Korea
                [ 2 ] Department of Radiology Inje University Busan Paik Hospital, College of Medicine Busan Republic of Korea
                [ 3 ] Department of Radiation Oncology Inje University Busan Paik Hospital, College of Medicine Busan Republic of Korea
                Author notes
                [*] [* ] Correspondence

                Hyun‐Kyung Lee, Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Busan Paik Hospital, Inje University College of Medicine, Bokji‐Ro 75, Busanjin‐Gu, 47392, Busan, Republic of Korea.

                Email: goodoc@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-7976-3753
                Article
                TCA14479
                10.1111/1759-7714.14479
                9250834
                35599247
                bb2dda59-64d5-4f27-b369-530b8b6855de
                © 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 02 May 2022
                : 28 March 2022
                : 03 May 2022
                Page count
                Figures: 2, Tables: 0, Pages: 3, Words: 1297
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                July 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:03.07.2022

                immunotherapy,lung cancer,oligometastasis,oligoprogression,radiotherapy

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