Thread by @changjeesuk1

1/
Our new editorial asks whether MDT for OMD has been too often treated as a one-time upfront intervention.

Have we overlooked the value of a comprehensive, longitudinal strategy—combining close surveillance with serial, strategic SABR when needed?

👉 doi.org/10.1016/j.canl…

2/
In SABR-COMET, re-tx w/ SABR occurred only in the MDT arm, but later trials—where clinical equipoise faded—showed frequent crossovers.
Re-tx rates reached 26% (up to 50%) in MDT arms and 36.5% (up to 78%) in controls.
This approach resembles how brain mets are managed.

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Simple tumor-growth modeling illustrates the potential advantage of integrating close surveillance w/ add’l MDT:
by periodically reducing tumor burden through serial interventions, disease control can be prolonged and survival substantially increased vs single upfront MDT.

4/
Classical RECIST v1.1 PFS may not fully capture the benefit of serial strategic MDT for new or subsequent mets.

We propose alternative endpoints—PFS2, mPFS, TTNT—each w/ distinct pros and cons, potentially reflecting the true impact of longitudinal MDT more effectively.

5/
Grateful to my OligoKarma guru @MitchCCLiu; to @FTHWU for tremendous help; and to SarahBaker and @emmadunne for their thoughtful contributions.

@ChadTangMD @CancerConnector @_ShankarSiva @drdavidpalma @jryckman3 @CJTsaiMDPhD @rweichselbaum @HimanshuNagarMD

@MitchCCLiu @FTHWU @emmadunne @ChadTangMD @CancerConnector @_ShankarSiva @drdavidpalma @jryckman3 @CJTsaiMDPhD @rweichselbaum @HimanshuNagarMD 6/
The key figure shows why endpoints like mPFS, PFS2, mPFS2, or TTNT may better capture the benefit of serial strategic RT than conventional PFS.
Excited that the upcoming STOP-II randomized trial adopts this framework.