Traitement des Métastases Pulmonaires dans le CBNPC EGFR-Muté et les Tumeurs Oncogène-Dépendantes en Oligoprogression sous Traitement Systémique
Lorsqu'un cancer métastatique progresse sur un nombre limité de sites pulmonaires tandis que le reste de la maladie reste contrôlé sous traitement systémique — un tableau appelé oligoprogression — une stratégie de prise en charge spécifique s'applique. Cette situation survient le plus souvent dans les tumeurs oncogène-dépendantes, notamment le cancer du poumon non à petites cellules (CBNPC) EGFR-muté.
La prise en charge repose sur une stratégie ablative locale dirigée vers le(s) site(s) pulmonaire(s) en progression, associée à la poursuite de l'agent systémique en cours — le protocole complet détaille la modalité préférentielle, la sélection des patients et l'algorithme thérapeutique complet.
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).