WCLC 2025 - Posters & ePosters-EP.12.16 Prolonged Survival in Oligometastatic ALK-Positive NSCLC: Impact of Local Ablative Therapy in a Multimodal Treatment Approach

EP.12.16 Prolonged Survival in Oligometastatic ALK-Positive NSCLC: Impact of Local Ablative Therapy in a Multimodal Treatment Approach

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This retrospective study from Karolinska University Hospital investigated oligometastatic disease (OMD) in ALK-positive non-small cell lung cancer (NSCLC) patients, focusing on long-term outcomes and the impact of local ablative therapy (LAT) combined with systemic ALK-targeted treatment. Among 160 metastatic ALK-positive NSCLC patients treated between 2009 and 2021, 64 (40%) developed OMD. Patients were followed for a median of 74 months, with a remarkable median overall survival (OS) exceeding 13 years (160 months), indicating durable long-term survival in this subset.<br /><br />OMD was classified into de novo, repeat, or induced categories. Most patients (58/64) were on ALK tyrosine kinase inhibitors (TKIs) at OMD diagnosis. LAT modalities included stereotactic radiosurgery, stereotactic body radiotherapy, external beam radiotherapy, and surgery, applied to 45 patients alongside continuation of ALK-TKIs. The median progression-free survival from initial systemic therapy (PFS1) and from first progression (PFS2) were both 14 months. Notably, the addition of LAT was associated with improved PFS after first progression, highlighting its beneficial role in multimodal management of OMD in ALK-positive NSCLC.<br /><br />Treatment-related toxicities were manageable and primarily low grade, including pneumonitis, radiation-induced brain toxicity, and esophagitis (all grade 1–3), suggesting that LAT is feasible and well-tolerated in carefully selected patients.<br /><br />This study supports current guideline recommendations advocating a multimodal treatment approach integrating systemic ALK-TKIs with local ablative therapy to achieve prolonged disease control in oligometastatic ALK-positive NSCLC. The findings demonstrate exceptional long-term survival and underscore the importance of incorporating LAT for optimal management of this distinct clinical subset.

Asset Subtitle

Caroline Kamali

Meta Tag

Speaker Caroline Kamali

Topic Metastatic Non-small Cell Lung Cancer – Targeted Therapy

Keywords

oligometastatic disease

ALK-positive non-small cell lung cancer

local ablative therapy

ALK tyrosine kinase inhibitors

long-term survival

progression-free survival

stereotactic radiosurgery

stereotactic body radiotherapy

multimodal treatment

treatment-related toxicities