Surgery for advanced lung cancer

For advanced lung cancer that has spread outside the lungs, the current standard of care is systemic anti-cancer treatment (chemotherapy, targeted agents, immunotherapy). The outcomes of current systemic treatment is so good, that length of life is significantly prolonged, so much so that we are now considering options on further lengthening survival.

We all know how important it is for patients to have more time with their loved ones and family, so in 2023 I set up RAMON an NIHR funded clinical trial as Chief Investigator in the UK to evaluate the outcomes of additional aggressive treatment to determine if and how much it would improve survival.[1]

Although systemic treatments has impressive results, often many patients are left with a small number of cancer deposits, and we don’t always know how best to deal with them. Initial small studies conducted in the USA reported (in the absence of significant disease progression and all sites of disease are still considered treatable) a 54% reduction in the risk of death with the addition of surgery and/or radiotherapy (local consolidation treatment) to all residual disease sites. The results were even more impressive at a 85% reduction in the risk of death if patients had successfully treated EGFR mutation or ALK translocation. [2,3]

To benefit from local consolidation treatment, all residual sites of disease need to be treatable. Although the RAMON study was not able to accrue sufficiently to continue to completion, we are still able to evaluate individual patients for suitability for local consolidation treatment, so if you would like to discuss your individual management, please contact me.

References

1.Beard C, Rogers CA, Fleming L, Conibear J, Evison M, Newsom-Davis T, Barwick T, Mills N, Stokes EA, Sousa PD, Batchelor T, Rawlinson J, Baos S, Lim E. Multimodality local consolidative treatment versus conventional care of advanced lung cancer after first-line systemic anti-cancer treatment: study protocol for the RAMON multicentre randomised controlled trial with an internal pilot. BMJ Open. 2023;13:e081650. doi: 10.1136/bmjopen-2023-081650

2. Gomez DR, Tang C, Zhang J, Jr GRB, Hernandez M, Lee JJ, Ye R, Palma DA, Louie AV, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Welsh JW, Gibbons DL, Karam JA, Kavanagh BD, Tsao AS, Sepesi B, Swisher SG and Heymach JV. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non–Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. Journal of Clinical Oncology. 2019;37:1558-1565.

3. Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H and Timmerman RD. Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2018;4:e173501.