Microwave ablation as local consolidative therapy for patients with extracranial oligometastatic EGFR-mutant non-small cell lung cancer without progression after first-line EGFR-TKIs treatment
Tóm tắt
Evidence from multiple clinical trials showed that local consolidative therapy (LCT) improved survival in oligometastatic non-small cell lung cancer (NSCLC) patients. In the present study, we aim to explore the potential role of microwave ablation (MWA) as LCT for epidermal growth factor receptor (EGFR)-mutant advanced NSCLC patients with extracranial oligometastasis. From January 2015 to December 2018, a total of 86 EGFR-mutant stage IIIB or IV NSCLC patients with extracranial oligometastasis were enrolled for retrospective analysis. MWA was used as LCT for all oligometastatic lesions and/or primary tumors in 34 patients without progression after first-line EGFR-TKIs therapy (consolidation group), while the other 52 patients received only TKIs until disease progression (monotherapy group). We calculated and compared the progression-free survival (PFS) and overall survival (OS) of the two groups. Patients with MWA consolidation therapy had significantly improved PFS (median 16.7 vs. 12.9 months, HR 0.44, 95% CI 0.22–0.88, P = 0.02) and OS (median: 34.8 vs. 22.7 months, HR 0.45, 95% CI 0.24–0.88, P = 0.04) than monotherapy group. MWA for LCT was identified as the independent predictive factor for better PFS (HR 0.46, 95% CI 0.37–0.82, P < 0.01) and OS (HR 0.57, 95% CI 0.33–0.91, P = 0.02). Most toxicities were mild and well tolerated. No patient had to discontinue EGFR-TKIs because of MWA complications. These findings suggest that MWA as local consolidative therapy after first-line EGFR-TKIs treatment leads to better disease control and survival than TKIs monotherapy in EGFR-mutant advanced NSCLC patients with extracranial oligometastasis. MWA as a novel option of LCT might be considered for clinical management of these patients.
Tài liệu tham khảo
de Baere T, Tselikas L, Catena V, Buy X, Deschamps F, Palussiere J (2016) Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging. 97(10):1019–1024
Gomez DR, Blumenschein GR Jr, Lee JJ, Hernandez M, Ye R, Camidge DR et al (2016) Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. 17(12):1672–1682
Gomez DR, Tang C, Zhang J, Blumenschein GR Jr, Hernandez M, Lee JJ et al (2019) Local consolidative therapy vs. maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer: long-term results of a multi-institutional, phase II, randomized study. J Clin Oncol. 8:JCO1900201
Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13(1):8–10
Inal A, Kodaz H, Odabas H, Duran AO, Seker MM, Inanc M et al (2018) Prognostic factors of patients who received chemotherapy after cranial irradiation for non-small cell lung cancer with brain metastases: a retrospective analysis of multicenter study (Anatolian Society of Medical Oncology). J Cancer Res Ther. 14(3):578–582
Jiang T, Chu Q, Wang H, Zhou F, Gao G, Chen X et al (2019) EGFR-TKIs plus local therapy demonstrated survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases. Int J Cancer 144(10):2605–2612
Juan O, Popat S (2017) Ablative therapy for oligometastatic non-small cell lung cancer. Clin Lung Cancer. 18(6):595–606
Khan AJ, Mehta PS, Zusag TW, Bonomi PD, Penfield Faber L, Shott S et al (2006) Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC). Radiother Oncol 81(2):163–167
Kim C, Hoang CD, Kesarwala AH, Schrump DS, Guha U, Rajan A (2017) Role of local ablative therapy in patients with oligometastatic and oligoprogressive non-small cell lung cancer. J Thorac Oncol. 12(2):179–193
Mitsudomi T, Morita S, Yatabe Y, Negoro S, Okamoto I, Tsurutani J et al (2010) Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial. Lancet Oncol. 11(2):121–128
Ni Y, Bi J, Ye X, Fan W, Yu G, Yang X et al (2016) Local microwave ablation with continued EGFR tyrosine kinase inhibitor as a treatment strategy in advanced non-small cell lung cancers that developed extra-central nervous system oligoprogressive disease during EGFR tyrosine kinase inhibitor treatment: a pilot study. Medicine (Baltimore). 95(25):e3998
Ni Y, Liu B, Ye X, Fan W, Bi J, Yang X et al (2019) Local thermal ablation with continuous EGFR tyrosine kinase inhibitors for EGFR-mutant non-small cell lung cancers that developed extra-central nervous system (CNS) oligoprogressive disease. Cardiovasc Intervent Radiol 42(5):693–699
Parikh RB, Cronin AM, Kozono DE, Oxnard GR, Mak RH, Jackman DM et al (2014) Definitive primary therapy in patients presenting with oligometastatic non-small cell lung cancer. Int J Radiat Oncol Biol Phys 89(4):880–887
Pusceddu C, Melis L, Sotgia B, Guerzoni D, Porcu A, Fancellu A (2019) Usefulness of percutaneous microwave ablation for large non-small cell lung cancer: a preliminary report. Oncol Lett. 18(1):659–666
Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E et al (2012) Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 13(3):239–246
Solbiati LA (2018) A valuable guideline for thermal ablation of primary and metastatic lung tumors. J Cancer Res Ther 14(4):725–726
Song Z, Qi H, Zhang H, Xie L, Cao F, Fan W et al (2017) Microwave ablation: results with three different diameters of antennas in ex vivo bovine and in vivo porcine liver. J Cancer Res Ther 13(5):737–741
Soria JC, Wu YL, Nakagawa K, Kim SW, Yang JJ, Ahn MJ et al (2015) Gefitinib plus chemotherapy versus placebo plus chemotherapy in EGFR-mutation-positive non-small-cell lung cancer after progression on first-line gefitinib (IMPRESS): a phase 3 randomised trial. Lancet Oncol. 16(8):990–998
Vogl TJ, Nour-Eldin NA, Albrecht MH, Kaltenbach B, Hohenforst-Schmidt W, Lin H et al (2017a) Thermal ablation of lung tumors: focus on microwave ablation. Rofo. 189(9):828–843
Vogl TJ, Nour-Eldin NA, Hammerstingl RM, Panahi B, Naguib NNN (2017b) Microwave ablation (MWA): basics, technique and results in primary and metastatic liver neoplasms—review article. Rofo. 189(11):1055–1066
Wei Z, Ye X, Yang X, Zheng A, Huang G, Li W et al (2017) Microwave ablation combined with EGFR-TKIs versus only EGFR-TKIs in advanced NSCLC patients with EGFR-sensitive mutations. Oncotarget. 8(34):56714–56725
Weichselbaum RR, Hellman S (2011) Oligometastases revisited. Nat Rev Clin Oncol. 8(6):378–382
Xu Q, Zhou F, Liu H, Jiang T, Li X, Xu Y et al (2018) Consolidative local ablative therapy improves the survival of patients with synchronous oligometastatic NSCLC harboring EGFR activating mutation treated with first-line EGFR-TKIs. J Thorac Oncol. 13(9):1383–1392
Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J et al (2014) Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases. J Surg Oncol 110(6):758–763
Yang X, Ye X, Huang G, Han X, Wang J, Li W et al (2017) Repeated percutaneous microwave ablation for local recurrence of inoperable stage I nonsmall cell lung cancer. J Cancer Res Ther. 13(4):683–688
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y et al (2018) Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-lung adenocarcinoma: a pilot study. J Cancer Res Ther. 14(4):764–771
Ye X, Fan W, Wang H, Wang J, Wang Z, Gu S et al (2018) Expert consensus workshop report: guidelines for thermal ablation of primary and metastatic lung tumors (2018 edition). J Cancer Res Ther. 14(4):730–744