What local treatment for the management of oligometastatic NSCLC?

The development of immunotherapy and targeted therapies in the management of non-small cell lung cancer has led to the emergence of the concept of oligometastatic disease, characterized by a limited number of metastases and a more favorable prognosis compared to multimetastatic disease. Local radical treatments (LRT, including radiotherapy, surgery and interventional radiology) of oligometastases could strengthen the response to systemic treatment while minimizing the emergence of resistant clones responsible for disseminated systemic progression. There is no trial comparing the different LRT modalities and the different techniques must be discussed in a multi-disciplinary tumor board. The use of LRT is supported by international consensuses and guidelines based on encouraging data from several randomized phase 2 trials, although strict assessment is needed beforehand in order to avoid unnecessary treatment at risk of toxicity. Supplementary ongoing phase 3 trials will soon strengthen the limited available level of evidence. The future integration of biomarkers should also contribute to a better understanding of the biological reality of oligometastatic disease and thus to an optimized selection of patients who can benefit from a combined therapeutic approach.