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Local ablative therapy in oncogenic-driven oligometastatic non-small cell lung cancer: present and ongoing

Vincent Fallet1, Lise Matton1, Antoine Schernberg2

  • 1Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France.

Translational Lung Cancer Research
|August 25, 2021
PubMed

Insights

Oligometastatic (OM) non-small cell lung cancer (NSCLC) with oncogenic drivers requires tailored treatment. Combining targeted therapies with local ablative therapy (LAT) may improve outcomes for select patients.

Area of Science:

  • Oncology
  • Medical Oncology
  • Thoracic Oncology

Background:

  • Oligometastatic (OM) disease signifies limited tumor spread.
  • Oncogenic-driven non-small cell lung cancer (NSCLC) represents 20-25% of cases, with increasing targeted therapy options.
  • Current OM-NSCLC guidelines lack specific recommendations for oncogenic-driven subtypes.

Purpose of the Study:

  • To review metastatic patterns in oncogenic-driven OM-NSCLC.
  • To evaluate the evidence for combining targeted therapies with local ablative therapy (LAT).
  • To propose strategies for selecting patients for curative-intent treatment.

Main Methods:

  • Narrative review of retrospective and prospective studies up to May 2020.
  • Analysis of metastatic tropism in EGFR and ALK-mutated NSCLC.
  • Assessment of tyrosine kinase inhibitors (TKI) and LAT combination benefits and risks.

Main Results:

  • Specific metastatic patterns identified: bone/pleural (EGFR), serous/brain (ALK).
  • Limited evidence exists for LAT in oncogenic-driven OM-NSCLC.
  • A combined TKI and LAT approach shows potential for improved survival.

Conclusions:

  • A proposed strategy involves initiating targeted therapy, followed by LAT, and then prolonged TKI maintenance.
  • This approach aims to enhance progression-free survival and overall survival.
  • Potential for cure exists in a subset of carefully selected patients.
Keywords:
Non-small cell lung cancer (NSCLC)anaplastic lymphoma kinase (ALK)epidermal growth factor receptor (EGFR)oligometastatic

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