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Case Reports
. 2019 Feb;26(1):e81-e93.
doi: 10.3747/co.26.4116. Epub 2019 Feb 1.

Canadian consensus: oligoprogressive, pseudoprogressive, and oligometastatic non-small-cell lung cancer

S A Laurie  1 , S Banerji  2 , N Blais  3 , S Brule  1 , P K Cheema  1 , P Cheung  1 , N Daaboul  3 , D Hao  4 , V Hirsh  3 , R Juergens  1 , J Laskin  5 , N Leighl  1 , R MacRae  1 , G Nicholas  1 , D Roberge  3 , J Rothenstein  1 , D J Stewart  1 , M S Tsao  1
Affiliations
Case Reports

Canadian consensus: oligoprogressive, pseudoprogressive, and oligometastatic non-small-cell lung cancer

S A Laurie et al. Curr Oncol. 2019 Feb.

Abstract

Background: Little evidence has been generated for how best to manage patients with non-small-cell lung cancer (nsclc) presenting with rarer clinical scenarios, including oligometastases, oligoprogression, and pseudoprogression. In each of those scenarios, oncologists have to consider how best to balance efficacy with quality of life, while maximizing the duration of each line of therapy and ensuring that patients are still eligible for later options, including clinical trial enrolment.

Methods: An expert panel was convened to define the clinical questions. Using case-based presentations, consensus practice recommendations for each clinical scenario were generated through focused, evidence-based discussions.

Results: Treatment strategies and best-practice or consensus recommendations are presented, with areas of consensus and areas of uncertainty identified.

Conclusions: In each situation, treatment has to be tailored to suit the individual patient, but with the intent of extending and maximizing the use of each line of treatment, while keeping treatment options in reserve for later lines of therapy. Patient participation in clinical trials examining these issues should be encouraged.

Keywords: Non-small-cell lung cancer, advanced; nsclc, advanced; oligometastatic disease; oligoprogression; pseudoprogression.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare the following interests: SAL has received honoraria from Pfizer, AstraZeneca, Boehringer Ingelheim, and Novartis; SB has served on advisory boards for AstraZeneca, Boehringer Ingelheim, Bristol–Myers Squibb, Eli Lilly, Novartis, Pfizer, and Roche, and has received research funding from AstraZeneca and Merck; NB has served on advisory boards for Amgen, AstraZeneca, Merck, Bayer, Boehringer Ingelheim, Bristol–Myers Squibb, Celgene, Eli Lilly, Novartis, Pfizer, Sanofi, and Roche; SB has received honoraria from AstraZeneca, Boehringer Ingelheim, Bristol–Myers Squibb, Eisai, and Merck; PKC has served as an advisor for AstraZeneca, Boehringer Ingelheim, Hoffmann–La Roche, Pfizer, Novartis, Takeda, Eli Lilly, and Bristol–Myers Squibb, and has received research funding from Boehringer Ingelheim and Hoffmann–La Roche; PC has received grants for investigator-initiated research projects from AbbVie, Pfizer, and Sanofi–Aventis; DH has served on advisory boards for AstraZeneca, Boehringer Ingelheim, Bristol–Myers Squibb, and Merck, and has received honoraria from Pfizer; VH has participated on advisory boards for AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol–Myers Squibb, Merck, Pfizer, and Roche; RJ has served as an advisor or consultant for AstraZeneca/MedImmune, Bristol–Myers Squibb, Merck, Pfizer/emd Serono, and Roche, has received honoraria from AstraZeneca, Bristol–Myers Squibb, Merck, Pfizer/emd Serono, and Roche, and has received research funding from AstraZeneca, Bristol–Myers Squibb, and Merck; JL has received honoraria for talks from AstraZeneca, Boehringer Ingelheim, Pfizer, and Roche, and her institution has received grant funding for research trials from AstraZeneca, Boehringer Ingelheim, Eli Lilly, and Roche; in the last 2 years, NL has received honoraria for independent unrelated continuing medical education from AstraZeneca, Bristol–Myers Squibb, and Merck; DR has received honoraria and support from Accuray, BrainLab, Elekta, Pfizer/emd Serono, Siemens Healthineers, and Varian Medical Systems; JR has received speaker and advisory board fees and institutional research support for clinical trials funded by Astra-Zeneca, Bristol–Myers Squibb, Merck, Pfizer, and Roche; DJS has received honoraria (2015–2018) from Roche Canada, Boehringer Ingelheim Canada, Novartis Canada, Merck Canada, AstraZeneca Canada, Bristol–Myers Squibb Canada, Exactis Innovation, and Pfizer Canada, and has received institutional research support from Boehringer Ingelheim, AstraZeneca, Novartis, Bristol– Myers Squibb, and Celgene; MST has received honoraria from AstraZeneca, Bristol–Myers Squibb, Merck, and Roche/Ventana, and a research grant from Merck. The remaining authors have no conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Combined positron-emission tomography–computed tomography imaging in March 2016 shows a 2.3 cm left upper lobe mass (left panel) and a positive (standardized uptake value 12.2) 1.8 cm mass in the left adrenal gland (right panel).
FIGURE 2
FIGURE 2
Computed tomography imaging in October 2016, before administration of pembrolizumab (left panel), and in February 2017, after 4 cycles of pembrolizumab (right panel).
FIGURE 3
FIGURE 3
Computed tomography imaging showing the course of illness: (A) Before administration of crizotinib, October 2010. (B) After crizotinib treatment, December 2010. (C) Continued response to crizotinib, January 2013. (D) A new metastasis in the right lung, March 2014. (E) Growth of the metastasis, February 2015. (F) An area of tumour growth in the left upper lung, January 2016. (G) An area of tumour growth in the left upper lung, May 2016. (H) Right lower lobe lesion after stereotactic body radiotherapy, April 2017. (I) Left upper lobe lesion after stereotactic body radiotherapy, April 2017.
FIGURE 4
FIGURE 4
Computed tomography imaging of chest at baseline (left panel) and after 6 weeks of gefitinib therapy (right panel), December 2015.
FIGURE 5
FIGURE 5
Magnetic resonance imaging of brain in June 2016 shows 1 of 6 enhancing lesions enlarging slightly.
FIGURE 6
FIGURE 6
Computed tomography imaging (A) at baseline; (B) at August 2016, showing an increase in in the size of the dominant left upper lobe mass, an increase in bilateral pulmonary nodules, appearance of new nodules, and lymphangitic carcinomatosis; and (C) at December 2016, showing a slight decrease in the size of the left upper lobe mass with osimertinib treatment.
FIGURE 7
FIGURE 7
Changes in computed tomography imaging over time. (A) In June 2016, compared with an earlier image, liver metastases have increased to 2.0 cm and 1.4 cm; the paratracheal node has increased to 1.2 cm; the right upper lung mass measures 3.7 cm (stable), but has changed in shape and decreased in attenuation. (B) In August 2016, liver metastases have decreased to 0.9 cm and 0.9 cm; the paratracheal node has decreased to 6 mm; the right upper lung mass has decreased to 2.6 cm. (C) In February 2017, the liver metastasis has increased to 1.7 cm; the paratracheal node is stable; and the right upper lung mass has increased to 9.3 cm, with invasion of the mediastinum.
See this image and copyright information in PMC

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