Update on Treatment of Oligometastatic Lung Cancer
More common than traditionally believed, about 50% of patients with non–small cell lung cancer (NSCLC) may have oligometastatic or oligoprogressive disease, which tends to be linked to a more indolent biology and a better prognosis than widespread metastases, according to a clinical review in the Journal of Oncology Practice. Corresponding author Joseph K. Salama, MD, of the Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, and colleagues consider this a “unique clinical opportunity” perhaps to treat these patients more aggressively, although identifying them before therapy currently is a challenge.
“Recent prospective randomized data have shown that aggressively managed patients with oligometastatic NSCLC have improved [progression-free survival] compared with maintenance therapy alone, and available survival data from multiple studies support a 5-year survival of up to 29% in these patients,” wrote the authors.
In this clinical review, Dr. Salama and colleagues explore what it means to be oligometastatic as well as prognostic factors. In addition, they review some of the clinical data on treatment options for this patient population, including surgery, radiation therapy, and molecularly targeted therapies.
However, most of the randomized data include patients with intracranial metastatic disease, with limited randomized data for those with NSCLC in extracranial sites of metastatic disease alone. Therefore, “additional studies are needed to improve patient selection, elucidate the optimal treatment schedule, and better define treatment-related toxicities,” they concluded.