Microwave ablation combined with EGFR-TKIs versus only EGFR-TKIs in advanced NSCLC patients with EGFR-sensitive mutations

Combination of microwave ablation and systemic treatments achieve a long survival time for a patient with metachronous advanced double primary lung and colon adenocarcinoma: A case report

Despite significant improvements that have been made in terms of progression-free survival and overall survival rates brought about by targeted therapy in non-small cell lung cancer (NSCLC), the emergence of drug resistance remains a limiting factor. However, a previous study has shown promising results by combining local microwave ablation (MWA) with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy for patients with oligometastatic NSCLC. The current study presented the case of a Chinese female patient who was identified as having lung adenocarcinoma (LADC) with EGFR exon 19 deletions (Del) in January 2014, and who experienced multiple instances of oligoprogression but showed a positive response to a combination of chemotherapy, MWA and a TKI drug. First, the patient was treated with four cycles of chemotherapy (120 mg docetaxel on day 1 and 40 mg cisplatin on days 1, 2 and 3; every three weeks as one cycle) and gefitinib (Iressa; 250 mg/day), maintaining a partial response for 17 months. In August 2015, a new solitary lesion was identified in the right lung and erlotinib (Tarceva; 150 mg/day) was administered for 3 months thereafter. In response, the patient underwent ablation of both the new right lung lesion and the primary left lung lesion in January 2016. Subsequently, a treatment course consisting of six cycles of chemotherapy (0.8 g pemetrexed on day 1 and 70 mg nedaplatin on days 1 and 2; every three weeks as one cycle) resulted in stable disease. In May 2016, the patient began treatment with osimertinib (AZD9291; 80 mg/day), resulting in a rapid shrinkage of the mediastinal lymph node after one month, which has been providing a benefit for the patient for 82 months and counting. Of note, the patient also developed metachronous colon cancer in January 2020, followed by the identification of right posterior liver metastases in February 2020 and lung metastases in May 2021 and in February 2022. To address this, the patient underwent radical resection of colon cancer and liver metastasectomy and received a combination of chemotherapy with bevacizumab, along with MWA for lung metastases. Remarkably, the patient has achieved long-term survival of 110 months. In conclusion, this case highlights the promising potential of combining MWA with systemic therapy for a patient with advanced LADC harboring EGFR exon 19 Del and metachronous lung and liver-metastasized colon adenocarcinoma. MWA effectively controlled both in situ oligoprogression and new oligoprogression, thereby enhancing the efficacy of systematic chemotherapy/TKI therapy. Furthermore, this case report emphasizes the importance of repeated histologic biopsies and genetic testing as reliable indicators for adjusting treatment regimens. Physicians should also remain vigilant regarding the occurrence of secondary primary carcinomas, and timely and accurate adjustments to treatment plans will be of significant benefit to patients in terms of treatment efficacy and overall quality of life.

Image-guided thermal ablation for patients with epidermal growth factor receptor-mutant nonsmall cell lung cancer

Nonsmall cell lung cancer (NSCLC) is treated by various therapies such as surgical intervention, radiotherapy, chemotherapy, molecular targeted therapy, and immunotherapy. Currently, molecular targeted therapy, including epidermal growth factor receptor (EGFR) inhibitors and Anaplastic Lymphoma Kinase (ALK) and Kirsten Rat Sarcoma viral Oncogene (KRAS) inhibitors, has received much attention and improved the prognosis of NSCLC. Nevertheless, the terminal point of molecular targeted drugs is resistance. Drug resistance has been classified into oligoprogression and extensive progression based on the tumor lesion progression after drug resistance. There is extensive research demonstrating that local therapy (surgical resection, radiotherapy, and thermal ablation) can prolong the survival of patients with drug resistance. This review is intended to determine the efficacy of image-guided thermal ablation in patients with NSCLC with EGFR mutation.

The efficacy of adding hyperthermia to the treatment of advanced NSCLC patients based on the states of EGFR

Background: The study aims to explore the efficacy of adding hyperthermia to the treatment of advanced NSCLC patients based on the states of epidermal growth factor receptor (EGFR).

Patients and methods: We included 205 advanced NSCLC patients who were received hyperthermia plus other treatment (hyperthermia group) or non- hyperthermia and other treatments (non- hyperthermia group). The OS and progression free survival (PFS) were retrospectively estimated. Using Kaplan-Meier and the log-rank test compare the OS and PFS between the groups.

Results: The median follow-up was 22 months. The Univariate analysis have shown that 1-year OS and PFS_first rates in the hyperthermia group and non- hyperthermia group were 83.3% vs 71.5% (P=0.010) and 62.0% vs 42.7% (P=0.001). The subgroup analyses revealed that patients didn’t have EGFR mutant who received hyperthermia had significantly higher 1 year OS and PFS_first rates than those treated with non- hyperthermia (OS: 79.1% vs 65.2% P=0.037, PFS: 64.2% vs 36.5%, P=0.001). For patients with EGFR mutation, there was no significant difference between the two groups. The PFS_first in first-line and PFS_post in posterior-line was no significant difference between the groups.

Conclusions: This retrospective study revealed that adding hyperthermia to the treatment of NSCLC patients without EGFR mutation had better prognosis than those who did not adding hyperthermia to the regimen. Moreover, adding hyperthermia in first-line or in posterior-line treatment was no significant difference. However, these results need more prospective studies to confirm the conclusions.

Effect of CT-guided microwave ablation for non-small cell lung cancer combined with severe chronic obstructive pulmonary disease

OBJECTIVE

To investigate the perioperative complications and safety of microwave ablation (MA) therapy for patient's non-small cell lung cancer (NSCLC) combined with severe chronic obstructive pulmonary disease (COPD).

METHODS

A total of 28 patients with NSCLC combined with severe COPD in our center were analyzed for complications during MA therapy and post-treatment outcomes.

RESULTS

All patients were successfully ablated by puncture, with a tumor efficiency of 85.7% and no death within 30 days. The tumor tissues showed hypodense changes, cavitation, and decreased CT values when the CT was reexamined 24 hours after surgery. A total of 24 patients showed different surgery-related complications, and were cured after targeted treatments. During the follow-up, the lung tumor disappeared, while the fibrous scars and foci as well as pulmonary cavity still remained. CT imaging examination showed there was no enhancement in the tissue after resection.

CONCLUSION

In this study, we confirmed that the complications of NSCLC combined with severe COPD after MA were manageable, safe and effective.

Survival prediction for non-small cell lung cancer patients treated with CT-guided microwave ablation: development of a prognostic nomogram

OBJECTIVES

To explore the outcomes of CT-guided percutaneous microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients, and then develop an effective nomogram to predict the survival.

METHODS

NSCLC patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (3:1). The primary outcome measurement was overall survival (OS), whose predictors were identified by univariate and multivariate analyses in the training cohort. Then, a predictive nomogram was developed to predict the OS, with the predictive accuracy evaluated by C-statistic and receiver operating characteristic in both the training and validation cohorts.

RESULTS

A total of 234 patients (training cohort: n = 176; validation cohort: n = 58) and 271 tumors with a median OS of 17.0 ± 12.2 months were included. The predictors selected into the nomogram included tumor diameter (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.37-3.30; p < 0.001), extrapulmonary metastases (HR, 1.77; 95% CI, 1.06-2.95; p = 0.030), tumor stage (HR, 1.38; 95% CI, 1.07-1.79; p = 0.013), tumor type (HR, 2.00; 95% CI, 1.48-2.72; p < 0.001) and post-MWA TKIs (HR, 0.55; 95% CI, 0.34-0.89; p < 0.001), based on the results of univariate and multivariate analyses. The C-statistic showed good predictive performance, with a C-statistic of 0.838 (95% CI, 0.779-0.897) internally and 0.808 (95% CI, 0.695-0.920) externally (training cohort and validation cohort, respectively).

CONCLUSIONS

The nomogram was effective in predicting the OS in NSCLC patients treated with MWA, and could be applied to identify patients who may benefit most from MWA and be helpful for clinical decision making.

Microwave ablation as local consolidative therapy for patients with extracranial oligometastatic EGFR-mutant non-small cell lung cancer without progression after first-line EGFR-TKIs treatment

OBJECTIVES

Evidence from multiple clinical trials showed that local consolidative therapy (LCT) improved survival in oligometastatic non-small cell lung cancer (NSCLC) patients. In the present study, we aim to explore the potential role of microwave ablation (MWA) as LCT for epidermal growth factor receptor (EGFR)-mutant advanced NSCLC patients with extracranial oligometastasis.

MATERIALS AND METHODS

From January 2015 to December 2018, a total of 86 EGFR-mutant stage IIIB or IV NSCLC patients with extracranial oligometastasis were enrolled for retrospective analysis. MWA was used as LCT for all oligometastatic lesions and/or primary tumors in 34 patients without progression after first-line EGFR-TKIs therapy (consolidation group), while the other 52 patients received only TKIs until disease progression (monotherapy group). We calculated and compared the progression-free survival (PFS) and overall survival (OS) of the two groups.

RESULTS AND CONCLUSION

Patients with MWA consolidation therapy had significantly improved PFS (median 16.7 vs. 12.9 months, HR 0.44, 95% CI 0.22-0.88, P = 0.02) and OS (median: 34.8 vs. 22.7 months, HR 0.45, 95% CI 0.24-0.88, P = 0.04) than monotherapy group. MWA for LCT was identified as the independent predictive factor for better PFS (HR 0.46, 95% CI 0.37-0.82, P < 0.01) and OS (HR 0.57, 95% CI 0.33-0.91, P = 0.02). Most toxicities were mild and well tolerated. No patient had to discontinue EGFR-TKIs because of MWA complications. These findings suggest that MWA as local consolidative therapy after first-line EGFR-TKIs treatment leads to better disease control and survival than TKIs monotherapy in EGFR-mutant advanced NSCLC patients with extracranial oligometastasis. MWA as a novel option of LCT might be considered for clinical management of these patients.

Usefulness of percutaneous microwave ablation for large non-small cell lung cancer: A preliminary report

The role of microwave ablation (MWA) in patients with non-small cell lung cancer (NSCLC) remains ill-defined. This retrospective study evaluated the oncological outcomes of CT-guided MWA in patients with large NSCLC. Kaplan-Meier analysis was used to evaluate overall survival (OS) and cancer-specific survival (CSS). The log-rank test was used to compare survival between patients with an NSCLC size greater or smaller than 4 cm. The likelihood of local tumor progression (LTP) was analyzed using a multivariable regression model. A total of 53 patients with 65 tumors were analyzed. The mean tumor size was 5.0±1.8 cm. At the 1-month CT scan, complete tumor ablation was observed in 44.6% of cases. In 18.5% of cases a redo-MWA session was carried out, while in 4.6%, a third MWA was necessary to obtain complete tumor necrosis. The mean follow-up was 28.1±20.6 months with a median duration of 21.5 months. The 1-year, 2-year, 3-year and 5-year OS rates were 78.2, 48.3, 34.8 and 18.3%, respectively. The median CSS was 25 months (95% CI 15.5–34.5). The 1-year, 2-year, 3-year and 5-year CSS rates were 84.3, 53.7, 42.1 and 30.0%, respectively. OS in patients with tumor size ≥4 cm was significantly lower when compared with those having smaller tumors (P=0.03). LTP was observed in 19 patients (35.8%). Incomplete tumor ablation [odds ratio (OR) 6.57; P<0.05] and tumor size ≥4 cm (OR 0.18; P<0.05) were significant independent predictors of LTP. In conclusion, CT-guided MWA may represent a useful tool in the multimodality treatment of patients with large advanced NSCLC.