Surgery for advanced lung cancer(stage IV)

In those patients with advanced lung cancer (stage IV) who are seeking active treatment, the current standard of care is systemic anti-cancer treatment. This involves chemotherapy, targeted treatments (for those with EGFR or ALK positive tumors) or immunotherapy.

For a proportion of patients, targeted treatments and immunotherapies have achieved spectacular results by holding the disease at bay, or greatly reducing the number and sites of disease. When this occurs, the question on most patients minds is if further (local consolidative) treatment such as surgery, radiotherapy, ablation to all the residual sites of disease can improve survival? A small study undertaken by Gomez reported that surgery, radiotherapy and/or ablation improved survival by 54% in this setting.[1] As the trial was relatively small, we need to know if this is a consistent finding with a greater degree of certainty.

From 2021, I have been leading on a UK wide multi-center trial called RAMON designed to answer this question.

For the participants in RAMON, half of those suitable for further localised treatment (surgery, radiotherapy, ablation) will be allocated (by chance) to further treatment (and half will not). We know that local consolidative treatment is difficult and carries a significant burden as well as significant cost, so we need to frame the question carefully - does local consolidative treatment improve survival, and if so at what cost (in terms of quality of life and financial cost)?

If you are interested to participate in RAMON or if you would like to discuss your individual management, do not hesitate to contact me.

Reference

1. Gomez DR, Tang C, Zhang J, Jr GRB, Hernandez M, Lee JJ, Ye R, Palma DA, Louie AV, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Welsh JW, Gibbons DL, Karam JA, Kavanagh BD, Tsao AS, Sepesi B, Swisher SG and Heymach JV. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non–Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. Journal of Clinical Oncology. 2019;37:1558-1565.