Oligo-Progression During First-Line Immunotherapy for Non-oncogene-addicted Metastatic NSCLC-Oligo-Progression During First-Line Immunotherapy for Non-oncogene-addicted Metastatic NSCLC

Oligo-Progression During First-Line Immunotherapy for Non-oncogene-addicted Metastatic NSCLC - PDF

Pdf Summary

This case study, led by Dr. Marco Tagliamento from Genoa, Italy, focuses on managing advanced non-small cell lung cancer (NSCLC) in a patient with no actionable molecular alterations but high PDL1 expression. The learning objectives include prescribing first-line immunotherapy per NCCN guidelines, managing oligo-progression with a multidisciplinary approach, and defining immunotherapy duration.<br /><br />The patient presents with a right apical lung mass, multiple pleural lesions, and enlarged lymph nodes. Biopsy confirmed adenocarcinoma NSCLC with PDL1 expression of 70-80%, negative for EGFR, ALK, ROS1, BRAF, MET, and RET mutations, but positive for KRAS G12C mutation. Brain MRI was negative for metastases. Disease is staged as cT3 N3 M1a. Imaging indicates oligo-progression with hypermetabolic lesions confirmed by FDG PET scan, including one in the right adrenal gland.<br /><br />Management involved a multidisciplinary team (MDT) discussion that recommended local ablative therapy (e.g., radiotherapy) to oligo-progressive lesions while continuing immunotherapy beyond progression. The patient’s performance status was ECOG 0, facilitating aggressive treatment options.<br /><br />After 12 weeks on pembrolizumab, CT scans showed a partial response. Treatment adjustment included considering switching pembrolizumab dosing from 200 mg every 3 weeks to 400 mg every 6 weeks. There is no consensus on optimal immunotherapy duration beyond two years or after oligo-progression treated with local therapies, necessitating individualized decisions based on efficacy and tolerability.<br /><br />Key takeaways emphasize selecting appropriate first-line immunotherapy regimens, recognizing the need for biomarkers to guide combining chemotherapy, employing multidisciplinary strategies for oligo-progression, utilizing local ablative therapies to extend systemic treatment benefits, and tailoring immunotherapy duration grounded in current evidence.<br /><br />This microlearning case supports thoracic oncology education and encourages further exploration in LungCancer 360 resources.

Keywords

non-small cell lung cancer

NSCLC

PDL1 expression

immunotherapy

pembrolizumab

oligo-progression

multidisciplinary team

local ablative therapy

KRAS G12C mutation

thoracic oncology