Tratamiento de Metástasis Pulmonares en CPCNP con Mutación EGFR y Tumores Impulsados por Oncogenes con Oligoprogresión Durante la Terapia Sistémica
Cuando el cáncer metastásico progresa en un número limitado de sitios pulmonares mientras el resto de la enfermedad permanece controlado bajo tratamiento sistémico — un patrón denominado oligoprogresión — se aplica una estrategia de manejo diferenciada. Esta situación se presenta con mayor frecuencia en tumores impulsados por oncogenes, incluyendo el cáncer de pulmón de células no pequeñas con mutación EGFR.
El manejo se centra en una estrategia ablativa local dirigida al(los) sitio(s) pulmonar(es) en progresión, combinada con la continuación del agente sistémico en curso — el protocolo completo detalla la modalidad preferida, la selección de pacientes y el algoritmo de tratamiento completo.
References
DOI: 10.21037/asj-21-81
- Oligoprogressive disease includes situations in which the tumor is not limited to a single or few metastatic lesions, but the failure of the initial systemic treatment is represented by a limited number of sites, potentially suitable for loco-regional approaches.
- Notably, this occurrence has been largely described in oncogenic-driven tumors, such as EGFR-mutant NSCLC.
- The development of new isolated lesions in a disease which is otherwise under control during systemic treatment creates a good opportunity for loco-regional approaches including surgery and radiation therapy, as such treatments might succeed in ablating a lesion characterized by cell clones resistant to the systemic therapy, hence potentially delaying the occurrence of actual, systemic progression requiring the switch to a subsequent line of therapy.
- In a study of ablative treatments in association with TKIs for NSCLC, patients receiving crizotinib for ALK-rearranged NSCLC (n=38) or erlotinib for EGFR-mutant NSCLC (n=27) were treated with local ablative treatments (either surgery or radiotherapy), resulting in approximately 6 months of additional disease control.
- The occurrence of oligoprogression can be treated with local approaches (in this case, preferably radiation therapy).