Palliative RadIotherapy of Multiple Metastatic Sites Before First Line of Systemic Therapy With Immune Checkpoint Inhibitors and Chemotherapy in Metastatic Non-Small-Cell Lung Cancer

Inclusion Criteria: * Signed consent to the study before the start of the procedures related to the protocol * Age ≥ 18 years at time of study entry * ECOG performance status 0-2 * Histologically or cytologically confirmed non-small cell lung cancer, with expression of PD-L1 of less than 50% * Stage IV metastatic Non-Small Cell Cancer confirmed by CT scan (of brain, chest and abdomen) or PET CT * Patients must be eligible for first line of systemic treatment with standard of care checkpoint inhibitor immune therapy and chemotherapy - according to the recommendations * inclusion of patients treated for few brain metastases (with surgery or ablative radiosurgery) is permitted (if the disease in the central nervous system is under control) * Prior surgery (diagnostic and therapeutic) and irradiation (for example: stereotactic irradiation of brain metastases) is permitted, provided that patients have fully recovered from the procedure at least 2 weeks before inclusion in the study * Patients treated with surgery or radiation and chemotherapy for limited non-small cell carcinoma in the past is permitted Exclusion Criteria: * Metastatic non-small cell carcinoma with known oncogenic alterations suitable for targeted treatment * Brain or meningeal metastases that are not under control * Other malignancy (other than non-small cell carcinoma) present that has progressed and/or requires active treatment * Previous malignancy, unless cured or complete remission has been achieved for a…