Pisano Chiara, De Filippis Marco, Jacobs Francesca, Novello Silvia, Reale Maria Lucia
Department of Oncology, S. Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy.
Cancers (Basel). 2022 Jan 30;14(3):718. doi: 10.3390/cancers14030718.
Personalized treatment based on driver molecular alterations, such as ALK rearrangement, has revolutionized the therapeutic management of advanced oncogene-addicted NSCLC patients. Multiple effective ALK tyrosine kinase inhibitors (TKIs), with the amelioration of the activity at central nervous system level, are now available, leading to substantial prognosis improvement. The exposure to TKIs triggers resistance mechanisms and the sequential administration of other TKIs and chemotherapy is, for the most part, not targeted. In this context, extending the benefit deriving from precision medicine is paramount, above all, when disease progression occurs in a limited number of sites. Retrospective data indicate that, in oligoprogressive disease, targeted therapy beyond progression combined with definitive local treatment of the progressing site(s) is an effective alternative. In these cases, a multidisciplinary approach becomes essential for an integrated treatment strategy, depending on the site of disease progression, in order to improve not only survival, but also quality of life. In this review we provide an updated and comprehensive overview of the main treatment strategies in cases of ALK rearranged oligoprogression, including systemic treatment as well as local therapy, and report a real-world clinical story, with the final aim of identifying the most promising management for this subset of patients.
基于驱动分子改变（如ALK重排）的个体化治疗，彻底改变了晚期对致癌基因成瘾的非小细胞肺癌（NSCLC）患者的治疗管理。现在有多种有效的ALK酪氨酸激酶抑制剂（TKIs），其在中枢神经系统水平的活性有所改善，从而使预后得到显著改善。接触TKIs会引发耐药机制，并且在大多数情况下，其他TKIs和化疗的序贯给药是无针对性的。在这种情况下，扩大精准医学带来的益处至关重要，尤其是当疾病在有限数量的部位进展时。回顾性数据表明，在寡进展性疾病中，进展后靶向治疗联合对进展部位的确定性局部治疗是一种有效的选择。在这些情况下，多学科方法对于综合治疗策略至关重要，这取决于疾病进展的部位，目的不仅是提高生存率，还能改善生活质量。在本综述中，我们提供了ALK重排寡进展病例主要治疗策略的最新全面概述，包括全身治疗和局部治疗，并报告了一个真实世界的临床病例，最终目的是确定该类患者最有前景的治疗方案。
