SABR Update Breast SSG June 2017: Enhancing Oligometastatic Disease Treatment

1. SABR Update Breast SSG June 2017

2. SABR in Bristol • First patient treated in February 2014 • In past 3 years: • 330 referrals • 250 patients treated • Includes patients treated with oligometastatic disease through CtE • Areas treated include: lung, liver, adrenal, lymph node and bone

3. Referral Centers GLOUCESTER CHELTENHAM NBT BATH WESTON UHB BARNSTABLE TAUNTON YEOVIL EXETER PLYMOUTH TORBAY

4. OVERALL SURVIVAL • OVERALL SURVIVAL AT 1 YEAR WAS 87% (95% CI 80 – 94%) AND 2 YEARS 78.8% (95% CI 66.8 – 90.8%). • THIS IS COMPARABLE WITH PUBLISHED DATA • PFS AND LRR WILL BE GENERATED ONCE WE HAVE FURTHER DATA FROM LOCAL CENTRES AND CENTRAL RADIOLOGY REVIEW

5. Case History: CT before and 12 months after treatment

6. But in reality……

7. Things are not quite so simple……

8. Indications for SABR • Medically-inoperable lung cancer • Good evidence base; standard of care • Oligo-metastatic disease • Synchronous • Metachronous • Oligo-progressive disease • Progression in a small number of sites while patient on maintenance treatment • Stage IV disease • Combining SABR with systemic treatment - immunotherapy

9. Oligometastatic Disease:Randomised trials • SARON trial • synchronous metastatic disease in NSCLC • Sequential chemoRT followed SABR to up to 3 metastatic sites vs palliative chemo • CORE trial • metachronous disease in lung, breast and prostate • SABR to up to 3 metastatic sites vs standard of care • Must have minimum of 6 months disease free interval • HALT trial • oligoprogressive disease in patients with driver mutation • SABR and continued TKI vs change in systemic treatment

10. CORE trial schema • NSCLC, breast or prostate cancer patients • Completed radical treatment • ≤3 extra cranial metachronous oligometastases • Suitable for SBRT Randomise (1:1) Standard of Care SBRT + Standard of Care • Standard of Care • defined prior to randomisation • May include further chemotherapy, hormone therapy, palliative radiotherapy or observation at PI discretion

11. Aims/Objectives • Primary • To evaluate if the addition of SBRT to SoC improves PFS • Secondary

12. Aims/Objectives • Secondary • To demonstrate feasibility of recruitment • To demonstrate deliverability of SBRT within dosimetric constraints • To evaluate if the addition of SBRT to SoC improves OS • To evaluate the acute and late toxicity associated with the addition of SBRT to SoC • To evaluate the lesion local control rates in those receiving SBRT • To compare the quality of life (QoL) in patients receiving SBRT compared to those receiving SoC alone • To investigate and evaluate resource use and costs of SBRT and SoC therapy within the trial setting.