“Oligometastatic” is hard to say but few words convey more hope to certain cancer patients, thanks to the pioneering efforts of the Dr. Ralph W. Weichselbaum, the 2018 recipient of ASCO’s 2018 David A. Karnofsky Memorial Award.
FEW METS COULD MEAN CURATIVE TREATMENT?
Weichselbaum’s acceptance speech, “Oligometastasis from Conception to Treatment,” will be published in the Journal of Clinical Oncology in the fall. In the interim, you can read Hanan Goldberg’s (@GoldbergHanan) excellent summary here.
Oligometastasis development photo courtesy of @GoldbergHanan
Oligometastasis describes patients who have only a few metastatic spots that are typically confined to one organ. Being oligometastatic means maybe, just maybe, you have a chance of being cured–provided you are treated aggressively and your cancer responds.
Reportedly there are more than 90,000 oligometastatic disease presentations in the four most common cancers in the US every year. This includes 10,000 prostate cancer patients, 14,000 breast cancer patients, 14,000 colorectal cancer patients and 50,000 lung cancer patients.
In 1999, Dr. Weichselbaum and his University of Chicago colleague, Samuel Hellman made the controversial suggestion that many patients with oligometastatic disease could be cured, depending on the extent of disease burden, with either surgery or targeted radiation therapy. As U of C’s John Easton reports, this notion, the spectrum theory of metastasis, has slowly been accepted, backed by a mounting series of reports of successful treatments.
OLIGOMETS TRIALS ARE ONGOING: MBCN IS SUPPORTING SOME OF THEM
The Metastatic Breast Cancer Network (MBCN) is proud to support Dr. Chmura’s work. (The accompanying picture from 2015 shows MBCN’s Shirley Mertz and me with U of C’s Drs. Nanda and Chmura). He is leading a national team of radiation oncologists in a national Phase II/III open trial that randomizes breast cancer patients with only 1-2 metastases, (“oligometastatic” breast cancer, to compare survival outcomes in standard of care therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical ablation.
The Research Leadership Award from MBCN ensures that participating study sites can perform needed biomarker tests of study participants. Outcomes of the trial could impact how metastatic disease is treated in the future in a subset of patients. (Here is a copy of Dr. Chmura’s 2015 presentation: Chmura talk_10_27_15.)
SOME PATIENTS AND DOCTORS DON’T KNOW WHAT OLIGOMETS IS
Some newly diagnosed metastatic breast cancer patients are never told they are oligometastatic. In some cases, health care providers know the term, but they don’t realize there are clinical trials these oligometastatic patients could pursue–they have more options than most with the disease. Some of my fellow patient advocates are working hard to get the word out.
“Metastatic breast cancer treatment is systemic, and many medical oncologists shun local treatment of nonsymptomatic tumors in favor of chemotherapy, rather than considering both in cases of limited metastatic spread, especially in the age of targeted drug therapies,” patient advocate Joan Mancuso wrote in 2013 as part of her patient advocacy work with SHARE Breast and Ovarian Support. “But that’s starting to change.”
Indeed, here is a link to a proposed Australian oligometastatic breast cancer registry.
Another US advocate has organized an online support group and hopes eventually to work with others to create a US patient registry of oligometastatic breast cancer patients. After reading online news accounts of Dr. Weichelbaum’s 2018 ASCO accolades, this patient advocate decided to contact him.
“What the heck, nothing to lose, and I sent him an email,” she told her online friends. “He will probably never read it and never respond but hey you never know! Will keep you all posted…”
Seemingly moments later she was posting again: “Um, you guys, he responded!” Their correspondence continued. “We’ve exchanged a couple more emails….he’s really such a nice man.”
The advocate shared with Dr. Weichselbaum that she learned of his work several years ago, soon after her de novo diagnosis with a solitary bone met. She subsequently enrolled in atrial at MD Anderson with Dr. Eric Strom. After completing aggressive chemo she had IMRT/SBRT radiation and has been NED (No Evidence of Disease) for almost two years and counting.
My friend is realistic–her treatment came with no guarantees–she takes things day by day. But she’s determined to educate others.
“We want oncologists who are unfamiliar with the term oligometastasis to understand it,” she says. “We think we are a unique subset and perhaps should be treated differently than other metastatic breast cancer patients… And a huge THANK YOU to Dr. Weichselbaum and his colleagues for all the important work they have done on behalf of patients like us. It give us all such hope.”
GOT OLIGOMETS? LET’S GET IN TOUCH!
If you PM me, I will pass along your contact info to the oligomets advocates–or please comment below. We will be in touch! (I am not oligometastatic, I am just helping out.)
Here is my favorite comment from an oligomets patient responding to Dr. Weichselbaum’s 2018 Karnofsky Award honors:
Well done Dr. Weichselbaum! The next round is on me!
Thank you and all of your colleagues for all you do! And thank you as well to patients like my friends who are participating in clinical trials and making a difference for ALL of us!
Editor’s Note: “The 46th David A. Karnofsky Memorial Award Lecture: Oligometastasis—From Conception to Treatment” has now been published. Full access requires a subscription; here is the abstract:
Metastasis from most adult solid tumors generally has been considered to be widespread and incurable. Here, I present clinical and molecular data to support the hypothesis that some metastases are limited in number and pace and are curable with ablative therapies. I advance the hypothesis that immunotherapy combined with radiotherapy may be a general strategy to increase the number of patients with metastatic cancer amenable to cure. I further suggest that, in the context of ablative radiotherapy, the potential synergies between immunotherapy and radiotherapy are principally within the local tumor microenvironment and require treatment of all or most sites of metastatic disease. Improvements in the molecular staging of metastasis, immunotherapy strategies, and radiotherapy delivery are likely to improve outcomes for patients with metastatic cancer. –Dr. Ralph R. Weichselbaum