Current treatment landscape for oligometastatic non-small cell lung cancer

Abstract

The management of patients with advanced non-small cell lung carcinoma (NSCLC) has undergone major changes in recent years. On the one hand, improved sensitivity of diagnostic tests, both radiological and endoscopic, has altered the way patients are staged. On the other hand, the arrival of new drugs with antitumoral activity, such as targeted therapies or immunotherapy, has changed the prognosis of patients, improving disease control and prolonging survival. Finally, the development of radiotherapy and surgical and interventional radiology techniques means that radical ablative treatments can be performed on metastases in any location in the body. All of these advances have impacted the treatment of patients with advanced lung cancer, especially in a subgroup of these patients in which all of these treatment modalities converge. This poses a challenge for physicians who must decide upon the best treatment strategy for each patient, without solid evidence for one optimal mode of treatment in this patient population. The aim of this article is to review, from a practical and multidisciplinary perspective, published evidence on the management of oligometastatic NSCLC patients. We evaluate the different alternatives for radical ablative treatments, the role of primary tumor resection or radiation, the impact of systemic treatments, and the therapeutic sequence. In short, the present document aims to provide clinicians with a practical guide for the treatment of oligometastatic patients in routine clinical practice.

Keywords: Oligometastatic, Non-small cell lung carcinoma, Non-small cell lung cancer, Oligometastasis

Core Tip: The treatment of oligometastatic non-small cell lung cancer patients remains controversial. The lack of solid evidence for the best therapeutic strategy and the multiple options currently available for both systemic and local treatments make this particular population of patients a challenge for clinicians. Improvement of surgical and radiotherapy techniques and the appearance of different ablative methods, such as radiofrequency or cryoablation, have made it possible to radically treat metastases in any location. In addition, recent prospective studies suggest that combining these ablative therapies with systemic treatments improve patient outcomes. We discuss the current status of the management of oligometastatic patients.