Harada Daijiro, Takigawa Nagio
Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama 791-0280, Japan.
Department of General Internal Medicine 4, Kawasaki Medical School, Okayama 700-8505, Japan.
Cancers (Basel). 2021 Nov 20;13(22):5823. doi: 10.3390/cancers13225823.
We reviewed the literature on oligoprogressive disease (OPD) and local ablative therapy (LAT) in patients with advanced non-small cell lung cancer (NSCLC). The frequency of OPD varies depending on its definition and is estimated to be between 15-47%. The implications of the strategy of continuing the same anticancer agents beyond progressive disease after LAT with radiation therapy for OPD are based on the concept of progression in which only a small number of lesions, not more than about four, proliferate after chemotherapy. In the case of OPD harboring driver mutations such as EGFR, prospective studies are underway. However, evidence from retrospective studies support this strategy, which is currently recommended in some guidelines. The prognosis in OPD cases during the administration of an immune checkpoint inhibitor (ICI) is relatively promising. Additionally, LAT with radiation for OPD after the first-line treatment of ICI with cytotoxic chemotherapy may overcome the resistance to the combination drug therapy due to an abscopal effect. To achieve long-term survival in advanced-stage NSCLC, it is important to verify the optimal method and timing of the therapy through prospective comparative studies as well as patient selection based on patient characteristics and biomarker levels.
我们回顾了有关晚期非小细胞肺癌（NSCLC）患者寡进展性疾病（OPD）和局部消融治疗（LAT）的文献。OPD的发生率因定义而异，估计在15%-47%之间。对于OPD，在接受放射治疗的LAT后，在疾病进展后继续使用相同抗癌药物的策略的依据是进展的概念，即在化疗后只有少数（不超过约四个）病灶增殖。对于存在EGFR等驱动基因突变的OPD病例，前瞻性研究正在进行中。然而，回顾性研究的证据支持这一策略，目前一些指南中也推荐该策略。在使用免疫检查点抑制剂（ICI）治疗期间，OPD病例的预后相对较好。此外，在一线使用细胞毒性化疗的ICI治疗后，对OPD进行放射治疗的LAT可能由于远隔效应而克服对联合药物治疗的耐药性。为了在晚期NSCLC中实现长期生存，通过前瞻性比较研究以及根据患者特征和生物标志物水平进行患者选择来验证最佳治疗方法和时机非常重要。
