Tratamiento del Cáncer de Pulmón de Células No Pequeñas (CPCNP) Recurrente o Metastásico (CPCNP): 2do Consenso Nacional de la Sociedad Panameña de Oncología (SPO). (Mesa 5)
[Tratamiento del Cáncer de Pulmón de Células No Pequeñas (CPCNP) Recurrente o Metastásico (CPCNP): 2do Consenso Nacional de la Sociedad Panameña de Oncología (SPO). (Mesa 5)]Erik Araúz1, J Moreno2, C Martin2, R Escobar2, E Chérigo2, K Britton2, A Crismatt2
1. Instituto Oncológico Nacional.; 2. Instituto Oncológico Nacional.
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Resumen
ResumenPara el manejo de los pacientes con CPCNP recurrente o avanzado, se debe tomar en consideración varios parámetros tales como; el tipo histológico, la presencia de biomarcadores, la edad, el estado funcional, las comorbilidades y las preferencias del paciente. El escenario óptimo de manejo para estos pacientes debe ser dentro de una unidad de tumores torácicos con una discusión multidisciplinaria que permita recomendar pruebas diagnósticas adicionales y evaluar el mejor tratamiento a seguir[1].
Todos los pacientes con estadios clínicos IV o enfermedad recurrente, y con adecuado estado funcional (ECOG 0-2, De las siglas en inglés “Eastern Cooperative Oncology Group”), deben recibir terapia sistémica paliativa con el objetivo de mejorar la supervivencia global (SG), la calidad de vida y controlar los síntomas asociados a la enfermedad (Tabla 1). La elección de la primera y posteriores líneas de tratamiento sistémico, va a depender de: el estado funcional del paciente, la disponibilidad de las pruebas moleculares y terapias dirigidas[1].
[Treatment of Recurrent or Metastatic Non-small Cell Lung Cancer (NSCLC): 2nd National Consensus of the Panamanian Oncology Society (SPO).]
Abstract
For the management of patients with recurrent or advanced NSCLC, several parameters should be taken into consideration, such as; the histological type, the presence of biomarkers, age, functional status, comorbidities and patient preferences. The optimal management scenario for these patients should be within a unit of thoracic tumors with a multidisciplinary discussion that allows recommending additional diagnostic tests and evaluating the best treatment to follow[1].
All patients with clinical stages IV or recurrent disease, and with adequate functional status (ECOG 0-2, of the acronym "Eastern Cooperative Oncology Group"), should receive palliative systemic therapy with the aim of improving overall survival (SG), the quality of life and control the symptoms associated with the disease (Table 1). The choice of the first and subsequent lines of systemic treatment will depend on: the functional state of the patient, the availability of molecular tests and targeted therapies[1].
Abstract
Resumen
Para el manejo de los pacientes con CPCNP recurrente o avanzado, se debe tomar en consideración varios parámetros tales como; el tipo histológico, la presencia de biomarcadores, la edad, el estado funcional, las comorbilidades y las preferencias del paciente. El escenario óptimo de manejo para estos pacientes debe ser dentro de una unidad de tumores torácicos con una discusión multidisciplinaria que permita recomendar pruebas diagnósticas adicionales y evaluar el mejor tratamiento a seguir[1].
Todos los pacientes con estadios clínicos IV o enfermedad recurrente, y con adecuado estado funcional (ECOG 0-2, De las siglas en inglés “Eastern Cooperative Oncology Group”), deben recibir terapia sistémica paliativa con el objetivo de mejorar la supervivencia global (SG), la calidad de vida y controlar los síntomas asociados a la enfermedad (Tabla 1). La elección de la primera y posteriores líneas de tratamiento sistémico, va a depender de: el estado funcional del paciente, la disponibilidad de las pruebas moleculares y terapias dirigidas[1].
[Treatment of Recurrent or Metastatic Non-small Cell Lung Cancer (NSCLC): 2nd National Consensus of the Panamanian Oncology Society (SPO).]
Abstract
For the management of patients with recurrent or advanced NSCLC, several parameters should be taken into consideration, such as; the histological type, the presence of biomarkers, age, functional status, comorbidities and patient preferences. The optimal management scenario for these patients should be within a unit of thoracic tumors with a multidisciplinary discussion that allows recommending additional diagnostic tests and evaluating the best treatment to follow[1].
All patients with clinical stages IV or recurrent disease, and with adequate functional status (ECOG 0-2, of the acronym "Eastern Cooperative Oncology Group"), should receive palliative systemic therapy with the aim of improving overall survival (SG), the quality of life and control the symptoms associated with the disease (Table 1). The choice of the first and subsequent lines of systemic treatment will depend on: the functional state of the patient, the availability of molecular tests and targeted therapies[1].
Citas
[1] Reck, M., S. Popat, N. Reinmuth, et al. "Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up." Annals of oncology 2014: 25 (Supplement 3): iii27–iii39.
[2] NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Non-small cell lung cancer, version 3.2017. Available at https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf, Accessed Jan 14, 2017.
[3] 1. Non-Small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ 1995; 311: 899–909.
[4] 2. Burdett S, Stephens R, Stewart L et al. Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: a systematic review and meta-analysis of individual patient data from 16 randomized controlled trials. J Clin Oncol 2008; 26: 4617–4625.
[5] Delbaldo C, Michiels S, Syz N et al. Benefits of adding a drug to a single-agent or a 2-agent chemotherapy regimen in advanced non-small-cell lung cancer: a meta-analysis. JAMA 2004; 292: 470–484.
[6] Pujol JL, Barlesi F, Daurès JP. Should chemotherapy combinations for advanced non-small cell lung cancer be platinum-based? A meta-analysis of phase III randomized trials. Lung Cancer 2006; 51: 335–345.
[7] Rossi A, Chiodini P, Sun JM et al. Six versus fewer planned cycles of first-line platinum-based chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual patient data. Lancet Oncol 2014; 15: 1254–1262.
[8] Schiller JH, Harrington D, Belani CP et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002; 346: 92–98.
[9] Scagliotti GV, Parikh P, von Pawel J et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008; 26: 3543–3551.
[10] Scagliotti G, Hanna N, Fossella F et al. The differential efficacy of pemetrexed according to NSCLC histology: a review of two phase III studies. Oncologist 2009; 14: 253–263.
[11] Ciuleanu T, Brodowicz T, Zielinski C et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 2009; 374: 1432–1440.
[12] Bronte G, Rolfo C, Passiglia F et al. What can platinum offer yet in the treatment of PS2 NSCLC patients? A systematic review and meta-analysis. Crit Rev Oncol Hematol 2015; 95: 306–317.
[13] Lilenbaum R, Villaflor VM, Langer C et al. Single-agent versus combination chemotherapy in patients with advanced non-small cell lung cancer and a performance status of 2: prognostic factors and treatment selection based on two large randomized clinical trials. J Thorac Oncol 2009; 4: 869–874.
[14] Zukin M, Barrios CH, Pereira JR et al. Randomized phase III trial of single-agent pemetrexed versus carboplatin and pemetrexed in patients with advanced non- small-cell lung cancer and Eastern Cooperative Oncology Group performance status of 2. J Clin Oncol 2013; 31: 2849–2853.
[15] Zhang X, Zang J, Xu J et al. Maintenance therapy with continuous or switch strategy in advanced non-small cell lung cancer: a systematic review and meta- analysis. Chest 2011; 140: 117–126.
[16] Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. The elderly lung cancer vinorelbine Italian Study Group. J Natl Cancer Inst 1999; 91: 66–72.
[17] Gridelli C, Perrone F, Gallo C et al. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst 2003; 95: 362–372.
[18] Quoix E, Zalcman G, Oster JP et al. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet 2011; 378: 1079–1088.
[19] Ciuleanu T, Brodowicz T, Zielinski C et al. Mainenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 2009; 374: 1432–1440.
[20] Cappuzzo F, Ciuleanu T, Stelmakh L et al. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo controlled phase 3 study. Lancet Oncol 2010; 11: 521–529.
[21] Ciuleanu T, Brodowicz T, Zielinski C et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 2009; 374: 1432–1440
[22] Paz-Ares LG, de Marinis F, Dediu M, et al. PARAMOUNT: final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013; 31: 2895–2902.
[23] Paz-Ares L, de Marinis F, Dediu M et al. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small- cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012; 13: 247–255.
[24] Di Maio M, Chiodini P, Georgoulias V et al. Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second-line treatment of advanced non-small-cell lung cancer. J Clin Oncol 2009; 27: 1836–1843.
[25] Shepherd FA, Dancey J, Ramlau R et al. Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol 2000; 18: 2095–2103.
[26] Hanna N, Shepherd FA, Fossella FV et al. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 2004; 22: 1589–1597.
[27] Cortot A.B., Audiger-Valette C., Molinier O. et al. Weekly paclitaxel plus bevacizumab versus docetaxel as second or third line treatment in advanced non-squamous non-small cell lung cancer (NSCLC): results from the phase III study IFCT-1103 ULTIMATE. J Clin Oncol 2016; 34 (May 20 Suppl.), 2016: abstr 9005.
[28] Herbst RS, Baas P, Kim DW et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet 2016; 387: 1540–1550.
[29] Brahmer J, Reckamp KL, Baas P et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 2015; 373: 123–135.
[30] Boolell V, et al. The Evolution of Therapies in Non-Small Cell Lung Cancer. Cancers 2015; 7:1815-46.
[31] Lynch et Al. Activating Mutations in the Epidermal Growth Factor Receptor Underlying Responsiveness of Non–Small-Cell Lung Cancer to Gefitinib NEJM 2004 350. 2129.
[32] Mok TS, Wu YL, Thongprasert S et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361: 947–957.
[33] Han JY, Park K, Kim SW et al. First-SIGNAL: first-line single-agent iressa versus gemcitabine and cisplatin trial in never-smokers with adenocarcinoma of the lung. J Clin Oncol 2012; 30: 1122–1128.
[34] Maemondo M, Inoue A, Kobayashi K et al. Gefitinib or chemotherapy for non- small-cell lung cancer with mutated EGFR. N Engl J Med 2010; 362: 2380–2388.
[35] Rosell R, Carcereny E, Gervais R et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012; 13: 239–246.
[36] Inoue A, Kobayashi K, Usui K et al. First-line gefitinib for patients with advanced non-small-cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. J Clin Oncol 2009; 27: 1394–1400
[37] Yang JCH, Wu YL, Schuler M et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015; 16: 141–151.
[38] Cortot AB, Jänne PA. Molecular mechanisms of resistance in epidermal growth factor receptor-mutant lung adenocarcinomas. Eur Respir Rev 2014; 23: 356–366.
[39] Yun CH, Mengwasser KE, Toms AV et al. The T790M mutation in EGFR kinase causes drug resistance by increasing the affinity for ATP. Proc Natl Acad Sci USA 2008; 105: 2070–2075.
[40] Jänne PA, Yang JCH, Kim DW et al. AZD9291 in EGFR inhibitor-resistant non- small-cell lung cancer. N Engl J Med 2015; 372: 1689–1699.
[41] Sueoka-Aragane N, Katakami N, Satouchi M et al. Monitoring EGFR T790 M with plasma DNA from lung cancer patients in a prospective observational study. Cancer Sci 2016; 107: 162–167.
[42] Kwak EL, Bang YJ, Camidge DR et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med 2010; 363: 1693–1703.
[43] Solomon BJ, Mok T, Kim DW, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. New England Journal of Medicine. 2014 Dec 4; 371[23]:2167-77.
[44] Shaw AT, Ou SH, Bang YJ, et al. Crizotinib in ROS1-rearranged non–small-cell lung cancer. New England Journal of Medicine. 2014 Nov 20; 371[21]:1963-71.
[45] Planchard D, Besse B, Groen HJ, et al. Dabrafenib plus trametinib in patients with previously treated BRAFV600E-mutant metastatic non-small cell lung cancer: an open-label, multicentre phase 2 trial. Lancet Oncol 2016; 17: 894–93.
[46] Hirsch, F. R., Scagliotti, G. V., Mulshine, J. Let al. Lung cancer: current therapies and new targeted treatments. The Lancet 2017; 389: 299–31.
[47] Reck M, Rodriguez-Abreu D, Robinson, AG, et al. Pembrolizumab versus chemotherapy for PD-L1–positive non-small-cell lung cancer. N. Engl. J. Med. 2016, 375, 1823–1833.
[48] Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 2015; 373: 123–35.
[49] Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 2015; 373: 1627–39.
[50] Herbst R, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet 2015; 387: 1540–50.
[51] Temel JS, Greer JA, Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733–742.
[52] Ferrell B, Sun V, Hurria A et al. Interdisciplinary palliative care for patients with lung cancer. Journal of pain and symptom management. 2015 Dec 31; 50[6]:758-67.
[53] Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012 Mar 10; 30[8]:880-7.
[54] Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. The Lancet. 2016 Dec 13.
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