Diagnostic and prognostic biomarkers in oligometastatic non-small cell lung cancer: a literature review

Abstract

This review aims to summarize the possibilities of recently discovered molecular diagnostic techniques in lung cancer, by evaluating their impact on diagnosis, monitoring, and prognosis in oligometastatic disease.Background: Oligometastatic non-small cell lung cancer (OM-NSCLC) is currently defined based on morphological rather than biological features. Major advances in the detection of molecular biomarkers in cell-free tumoral DNA and the models of oncogene addiction make as feasible an early diagnosis and guide the therapeutic decision-making progress to improve the prognosis.Methods: This narrative review EXAMINES current approaches of diagnosis, monitoring, and prognosis of OM-NSCLC and describes the fast-evolving therapeutic scenario of this disease. We provide an overview of the powerful capability of liquid biopsy techniques applied to blood and fluid and we focus on the technological advancement of circulant biomolecular factors in OM NSCLC pathology, starting from apparently simpler models such as oncogene addicted tumors to evaluate themselves in the light of treatment with immune-checkpoint inhibitors.Conclusions: A better understanding of spatial and temporal evolution of oligometastatic diseases would contribute to a more accurate diagnosis and tailored treatment. Data from prospective clinical trials in the early stage of disease, coupled with knowledge of genetic characteristics of lung tumors, are warranted. These efforts would lead to improving the possibility to eradicate the residual disease in these low burden tumoral settings, thus enhancing the definitive cure perspectives.

Role of local ablative treatment in oligometastatic non-small cell lung cancer: a meta-analysis

“…In addition to the number of metastases, the size and location of metastases have an impact on the prognosis. The identification of related biological markers, such as cell-free DNA and circulating tumor cells, is urgently needed to identify the disease characteristics of oligometastasis that may benefit from LAT 45 , 47 .…”

“…The meta-analysis included six oligometastases and one polymetastasis NSCLC studies; therefore, some heterogeneity was considered. A systematic review should collect all available evidence, and the purpose of a meta-analysis is to provide integrated information based on extensive literature to help clinical decisions, as referenced in the Cochrane manual 46 , 47 . The previous study included only six oligometastasis studies, which required a more extensive search, and no subgroup analyses were performed.…”

The Road to Dissemination: The Concept of Oligometastases and the Barriers for Widespread Disease

“…Even more interesting would be the ability to distinguish a oligometastatic state through liquid biopsies: detecting relevant biological molecules and macrostructures in peripheral blood, such as circulating tumor DNA (ctDNA), circulating microRNA, circulating free RNA, extracellular vesicles, or circulating tumor cells [60]. Recent studies have indicated the clinical utility of ctDNA for molecular residual disease assessment, monitoring recurrence, and treatment response in patients, with emerging applications in oligometastatic patients [61][62][63][64][65].…”

Local Consolidative Therapy for Oligometastatic Non-Small Cell Lung Cancer

“…Although interpretation is limited by small sample size, these findings may suggest that the survival benefit associated with LAT may be mediated by enhanced early immune-mediated tumor killing in oligometastatic NSCLC and that ctDNA could be used post-LAT for the assessment of tumor response and/or early recurrence. However, care should be taken with this approach as levels of ctDNA shedding can vary among patients with intrathoracic only versus extra-thoracic involvement of disease [ 74 ].…”