Abstract

Since 1995, when the concept of oligometastatic non-small cell lung cancer was first described, no high-level evidence has been introduced for management of those patients subset. Data from retrospective reports and analysis and from every-day clinical practice revealed that some of the non-small cell lung cancer patients with a few metastases could benefit significantly with local radical treatment approach of primary and metastatic lesions. Recent advances in modern local treatment approaches with minimally invasive surgery and stereotactic radiotherapy, as well as introduction of immunotherapy, open new field of interest for personalized treatment of limited metastatic non-small cell lung cancer. In this report, we are summarizing limited data of case reports, retrospective studies and few randomized studies of patients with oligometastatic non-small cell lung cancer and discuss challenges of treatment in the era of molecular targeted therapy and immunotherapy.

Highlights

  • Lung cancer is the leading cause of cancer mortality worldwide, with over 1.7 million deaths and over 2 million newly diagnosed cases annually [1]

  • We present most relevant scientific evidence regarding oligometastatic non-small cell lung cancer (NSCLC) and discuss future perspectives in treatment of these patients in the era of molecular targeted treatment and immunotherapy

  • Weckhard et al reported that 49% of anaplastic lymphoma kinase (ALK) or epidermal growth factor receptor (EGFR) positive metastatic NSCLC patients are treated with tyrosine kinase inhibitors (TKI) presented with intracranial or extracranial oligoprogression suitable for local treatment [20]

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Summary

Introduction

Lung cancer is the leading cause of cancer mortality worldwide, with over 1.7 million deaths and over 2 million newly diagnosed cases annually [1]. More than a half of all new diagnosed patients with non-small cell lung cancer (NSCLC) presents in stage IV disease with a median overall survival (OS) of 10–12 months. The sub segment of patients in stage IV was recognized years ago with different clinical presentation and prolonged survival that overcomes expected for metastatic disease [3]. Oligometastatic disease was first described in 1995 as a state of limited systemic metastatic burden in which treatment of oligometastases with radical local therapies could be curative in selected patients [3, 4]. Clinical data indicate that the number of patients with oligometastatic disease that undergo ablative local treatment is increasing at a great rate [5]. Lung Cancer - Modern Multidisciplinary Management positron emission tomography/computed tomography (18F-FDG PET/CT) and magnetic resonance imaging (MRI), oligometastatic NSCLC patients who benefit most from radical treatment could be selected precisely [6]. We present most relevant scientific evidence regarding oligometastatic NSCLC and discuss future perspectives in treatment of these patients in the era of molecular targeted treatment and immunotherapy

Definition
Incidence
Prognostic factors
Treatment
Challenges in the era of molecular targeted and immunotherapy
Molecular targeted therapy in oligometastatic NSCLC
Combining immunotherapy and radiotherapy
Beyond progression: oligoprogression in NSCLC patients
Findings
Conclusion
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