Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have shown clinical activity for patients withEGFR-mutated non-small-cell lung cancer (NSCLC). However, the development of resistance to EGFR-TKIs is almost inevitable, posing a significant barrier to long-term survival. Local ablative therapy (LAT) may facilitate the prolonged survival of patients with oligometastatic NSCLC. Therapeutic combinations of EGFR-TKIs and LAT for residual disease have been suggested to be potentially effective inEGFR-mutated NSCLC with induced oligometastatic disease, wherein a few lesions remain following initial EGFR-TKI treatment. Various resistance pathways for third-generation EGFR-TKIs including osimertinib, current standard of care for patients withEGFR-mutated NSCLC, have also been identified. In addition to resistance mechanisms, the disease-progression pattern may be an essential element for achieving long-term response and survival. Oligo-progressive disease is a state in which only a few lesions become resistant, whereas many lesions remain controlled with effective systemic therapy. Previous studies have shown that LAT for all oligo-progressive lesions could provide survival benefits. This review discusses the current treatment options and potential future therapeutic developments for patients withEGFR-mutated NSCLC who have synchronous oligometastatic disease, oligo-residual disease during treatment with EGFR-TKIs, and oligo-progressive disease following resistance to EGFR-TKIs.
表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）对携带EGFR突变的非小细胞肺癌（NSCLC）患者显示出临床疗效。然而，EGFR-TKIs耐药性的产生几乎不可避免，成为长期生存的重要障碍。局部消融治疗（LAT）可能延长寡转移NSCLC患者的生存期。针对EGFR-TKI治疗后残留的少数病灶（即诱导性寡转移病灶），EGFR-TKIs联合LAT的治疗方案被认为可能对EGFR突变NSCLC有效。目前作为EGFR突变NSCLC标准治疗的三代EGFR-TKIs（如奥希替尼）的多种耐药途径也已被确认。除耐药机制外，疾病进展模式可能是实现长期应答和生存的关键因素。寡进展疾病是指仅少数病灶产生耐药，而多数病灶在有效全身治疗下仍受控制的状态。既往研究表明，对所有寡进展病灶实施LAT可带来生存获益。本综述探讨了EGFR突变NSCLC患者在同步寡转移、EGFR-TKIs治疗期间出现寡残留病灶以及EGFR-TKIs耐药后发生寡进展等不同情况下的现有治疗方案及未来潜在治疗发展方向。
肿瘤(癌症)患者之家