Steven J. Chmura, MD, PhD, Discusses Relevance of Additional Metastases-Directed Treatment in Oligometastatic Breast Cancer

At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® spoke with Steven J. Chmura, MD, PhD, professor of radiation and cellular oncology, director of Clinical and Translational Research for Radiation Oncology, and Scientific Director of Cancer Clinical Trials at the University of Chicago Medicine, about the phase 2R/3 NRG-BR002 trial (NCT02364557), which showed no benefit of additional metastases-directed treatment (MDT) of stereotactic body radiotherapy and/or surgical resection when patients with newly oligometastatic breast cancer were treated with standard of care (SOC) systemic therapy.

In arm 1 involving SOC systemic therapy, the median progression-free survival (PFS) was 23 months (70% CI, 18-29), compared with arm 2 of SOC systemic therapy plus MDT in which the median was 19.5 months (70% CI, 17-36; HR, 0.92; 70% CI, 0.71-1.17; 1-sided log-rank P = .36). At 24 months, the PFS rate in arm 1 was 45.7% (70% CI, 38.9%-52.5%) and was 32.8% (70% CI, 26.0%-39.5%) at 36 months. In arm 2, the 24- and 36-month PFS rates were 46.8% (70% CI, 39.2%-54.3%) and 38.1% (70% CI, 29.7%-46.6%), respectively.

Transcript:

Prior to this study, there were innumerable single-institution, single-arm studies that showed great promise. Women who had limited spread of oligometastases if they were treated aggressively and lived a long time and did quite well. [Different treatments were] never randomized in a true fashion to control for that. The outcome [of this study] shows why we have to [rely on] science. Talk about real-world data is fine, but it doesn’t tell us anything because those same real-world data had [everyone] assuming this worked. The bottom line is that it doesn’t work. It’s true that patients who present with a limited spread of disease do very well; systemic therapies work extremely well, and survival is fantastic. But it has nothing to do with the actual local intervention.

Reference

Chmura SJ, Winter KA, Woodward WA, et al. NRG-BR002: A phase IIR/III trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer (NCT02364557). J Clin Oncol. 2022; 40(suppl 16):1007-1007. doi: 10.1200/JCO.2022.40.16_suppl.1007