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Managing Oligometastatic Lung Cancer

Oligometastatic lung cancer is cancer that has spread from the primary location to one or a few other organs. In most cases, oligometastatic lung disease occurs in the brain. Synchronous oligomestatases can occur during the initial diagnosis, while metachronousoligometastases are seen within six months of diagnosis. The oligometastatic phenotype is typically a function of the current biology of cancer in the body.

In several clinical trials to manage oligometastatic lung cancer:

 Oligometastatic non-small cell lung cancer patients who received locally ablative therapy after systematic therapy showed improvement in their progression-free survival and overall survival.

 It was noted that most of the patients who benefited from this trial were those with 0 to 1 metastatic lesion.

 In a screening study, patients with up to 5 metastatic foci in different types of cancers were given definitive treatment and standardized palliative therapy with stereotactic radiotherapy. Improvement in progression-free survival and overall survival was observed in this group as well. A randomized clinical trial is underway to confirm these results.

 Another trial was conducted to assess the outcomes in patients with oligometastatic lung cancer when immunotherapy is added to locally ablative therapy. The patients were given pembrolizumab (Keytruda) for six months with excellent results.

These few trials and many others have confirmed that locally ablative therapy can be used as a treatment option for oligometastatic lung disease. As for immunotherapy, efforts are ongoing to help identify its biomarkers to help direct oncologists on the right patients who can receive the combination with definitive results.

Currently, randomized trials are being carried out to evaluate the efficacy of locally ablative therapy in treating oligometastatic lung cancer. Also, the role of immunotherapy has to be confirmed in such a setting to help improve outcomes for patients. Clinicians now have an essential job of identifying which patients can benefit from this therapy.

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