Analysis of further disease progression in metastatic non-small cell lung cancer: Implications for locoregional treatment

To determine whether in the natural history of metastatic non-small cell lung cancer (NSCLC) a time interval exists when metastases are limited in number and/or destination organs. Thirty-eight stage IIIB (pleural effusion)/IV NSCLC patients were treated on a phase II trial of oxaliplatin and paclitaxel. Patients' charts were reviewed and all sites of disease at initial presentation and at subsequent follow-ups were recorded, including the number of organs involved and the number of individual metastatic sites. At presentation, 74% of patients had metastases confined to one or two organs (including the lung primary). Fifty percent had ≤3 metastatic sites in addition to the lung primary. At last follow-up, 17 patients developed new lesions, 14 in a new organ and 3 in a previously involved organ. Nineteen (50%) had stable (n=12) or progressive (n=7) disease in initially involved sites without developing any new metastatic tumors. Among the 17 patients who presented with ≤4 metastatic sites and no pleural effusion, 11 (65%) had stable or progressive disease in initially involved sites without developing new metastases. These results suggest that a subset of patients who present with metastatic NSCLC may not have widely disseminated disease and that some form of local treatment combined with systemic therapy might be beneficial in these patients. Our data support the feasibility of a clinical trial that incorporates local therapies to sterilize metastases in patients with NSCLC.