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Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements

SIMPLE SUMMARY: The growing efficacy and availability of new targeted systemic therapies have markedly improved the prognosis of metastatic lung cancer patients harboring ALK rearrangements. The use of effective targeted therapies capable of maintaining a prolonged control of disease, for as long as...

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Autores principales: Pisano, Chiara, De Filippis, Marco, Jacobs, Francesca, Novello, Silvia, Reale, Maria Lucia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833409/
https://www.ncbi.nlm.nih.gov/pubmed/35158987
http://dx.doi.org/10.3390/cancers14030718
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author Pisano, Chiara
De Filippis, Marco
Jacobs, Francesca
Novello, Silvia
Reale, Maria Lucia
author_facet Pisano, Chiara
De Filippis, Marco
Jacobs, Francesca
Novello, Silvia
Reale, Maria Lucia
author_sort Pisano, Chiara
collection PubMed
description SIMPLE SUMMARY: The growing efficacy and availability of new targeted systemic therapies have markedly improved the prognosis of metastatic lung cancer patients harboring ALK rearrangements. The use of effective targeted therapies capable of maintaining a prolonged control of disease, for as long as possible, is paramount to ensure the best survival outcomes. In this regard, in cases of oligoprogression, “beyond progression” systemic treatment added to local ablative therapies is considered a feasible option in an attempt to improve the quality and quantity of patients’ lives, even if based on retrospective data. Certainly, treatment of ALK rearranged lung cancer patients with oligoprogressive disease must be individualized and based on multidisciplinary decisions. Above all, when further molecular targeted therapies are available, options must always be evaluated, especially in case of cerebral progression. In this review, we provide an updated and comprehensive overview of the main treatment strategies in cases of ALK rearranged oligoprogression. ABSTRACT: 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.
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spelling pubmed-88334092022-02-12 Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements Pisano, Chiara De Filippis, Marco Jacobs, Francesca Novello, Silvia Reale, Maria Lucia Cancers (Basel) Review SIMPLE SUMMARY: The growing efficacy and availability of new targeted systemic therapies have markedly improved the prognosis of metastatic lung cancer patients harboring ALK rearrangements. The use of effective targeted therapies capable of maintaining a prolonged control of disease, for as long as possible, is paramount to ensure the best survival outcomes. In this regard, in cases of oligoprogression, “beyond progression” systemic treatment added to local ablative therapies is considered a feasible option in an attempt to improve the quality and quantity of patients’ lives, even if based on retrospective data. Certainly, treatment of ALK rearranged lung cancer patients with oligoprogressive disease must be individualized and based on multidisciplinary decisions. Above all, when further molecular targeted therapies are available, options must always be evaluated, especially in case of cerebral progression. In this review, we provide an updated and comprehensive overview of the main treatment strategies in cases of ALK rearranged oligoprogression. ABSTRACT: 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. MDPI 2022-01-30 /pmc/articles/PMC8833409/ /pubmed/35158987 http://dx.doi.org/10.3390/cancers14030718 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Pisano, Chiara
De Filippis, Marco
Jacobs, Francesca
Novello, Silvia
Reale, Maria Lucia
Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title_full Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title_fullStr Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title_full_unstemmed Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title_short Management of Oligoprogression in Patients with Metastatic NSCLC Harboring ALK Rearrangements
title_sort management of oligoprogression in patients with metastatic nsclc harboring alk rearrangements
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833409/
https://www.ncbi.nlm.nih.gov/pubmed/35158987
http://dx.doi.org/10.3390/cancers14030718
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