Operating in Oligometastatic Lung Cancer: Dr. Antonoff Discusses Key Advances

Mara Antonoff, MD, a thoracic surgeon at the University of Texas MD Anderson Cancer Center, joined Lung Cancers Today to share insights on operating in oligometastatic lung cancer.

Dr. Antonoff, who recently presented on the topic during the American Association of Thoracic Surgeons Annual Meeting, explained why it’s important to address misconceptions surrounding operating in oligometastatic disease.

“It’s very common for individuals who don’t have a lot of knowledge in this specific area to feel like when there’s a diagnosis of stage IV lung cancer—disease that has spread throughout the body—that our goals of care and our goals of treatment really should shift toward palliation, toward perhaps minor extension of life,” Dr. Antonoff said.

There are important advances in the field that have changed the situation, she explained.

“It’s only in the last 10 years or so that we have seen huge progress in ways that we can find groups of patients who may benefit from a more aggressive approach,” she said.

This progress began with some of the key trials in oligometastatic disease, Dr. Antonoff explained, noting that research is helping to inform which patients are the right candidates for surgery.

“Oligometastatic disease, for the purpose of our clinical trials here at MD Anderson, as well as the clinical practice guidelines recently put forth by the Society of Thoracic Surgeons, has stuck to a definition of three or fewer sites of disease, with all mediastinal lymph nodes considered one site of disease,” she said. “It’s through this very selective group of patients that we were initially able to see dramatic improvement in results with any type of local therapy consisting of surgery or radiation.”

Beyond the “excellent outcomes” that have been shown with surgery for patients with oligometastatic disease, Dr. Antonoff explained that “there is a role for surgical therapy” in patients with polymetastatic disease who are properly selected and have disease control.

“Even in patients with oligoprogressive disease, as long as all sites of disease can be addressed, there are certain patients that can benefit from local therapy,” she said. “What we are finding is that many of the previous exclusion criteria may not be exclusion criteria.”