From the Guidelines
Treatment options for lung cancer with peritoneal metastasis primarily involve systemic therapy, focusing on platinum-based combination chemotherapy to improve quality of life and extend survival. The main treatment approach typically involves regimens such as cisplatin or carboplatin with pemetrexed for non-squamous non-small cell lung cancer (NSCLC), or with gemcitabine or paclitaxel for squamous NSCLC, as supported by studies indicating the benefit of platinum-based chemotherapy in metastatic disease 1.
Key Considerations
- Platinum-based chemotherapy is beneficial for patients with stage IV disease who have a good performance status (PS) 1.
- The prognosis for advanced inoperable lung cancer remains poor, despite the development of new chemotherapy regimens 1.
- Recent data show that early palliative care combined with standard care improves quality of life, mood, and survival in patients with metastatic NSCLC 1.
- For patients with specific genetic alterations, targeted therapies offer better outcomes, such as osimertinib for EGFR mutations, alectinib for ALK rearrangements, or entrectinib for ROS1 or NTRK fusions.
- Peritoneal metastases may require additional symptom management, including paracentesis for ascites, pain management, and nutritional support.
Treatment Selection
Treatment selection depends on the patient's molecular profile, histology, performance status, and comorbidities, with the goal of extending survival while maintaining quality of life. Given that peritoneal involvement generally indicates a poor prognosis with median survival typically less than one year, integrating palliative care early is crucial to address symptoms and improve quality of life 1.
Symptom Management
- Palliative care should be integrated early to address symptoms and improve quality of life.
- Additional symptom management for peritoneal metastases includes paracentesis for ascites, pain management, and nutritional support.
From the Research
Incidence of Lung Cancer and Peritoneal Metastasis
- The incidence of lung cancer with peritoneal metastasis is rare, with most cases involving multiple metastatic sites 2, 3, 4.
- Peritoneal carcinomatosis is a rare clinical event in lung cancer patients, with the most common metastatic sites being the brain, bone, liver, adrenal glands, thoracic cavity, and distant lymph nodes 3.
Treatment Options for Lung Cancer with Peritoneal Metastasis
- Treatment options for lung cancer with peritoneal metastasis include palliative intraperitoneal chemotherapy 2, targeted therapy with osimertinib 3, and palliative chemotherapy with gemcitabine, cisplatin, and bevacizumab 4.
- The use of molecular therapies, such as targeted therapy and immunotherapy, has improved progression-free survival and overall survival in lung cancer patients, increasing the chance of identifying peritoneal metastasis 3, 5.
- Pembrolizumab plus chemotherapy has been shown to significantly prolong overall survival and progression-free survival in patients with metastatic, squamous non-small-cell lung cancer 6.
Challenges and Future Perspectives
- Challenges in the treatment of lung cancer with peritoneal metastasis include resistance to targeted therapies, the high cost of certain treatments, and the need for further research on new drugs 5.
- Future perspectives in the treatment of lung cancer with peritoneal metastasis include the development of new targeted therapies and immunotherapies, as well as the improvement of existing treatments 5.