Table 3.
Hypothetical patient scenarios provided in survey
| Synchronous oligometastatic disease |
|---|
| A 75-year-old otherwise healthy man is incidentally found to have a prostatic nodule on digital rectal examination. PSA is found to be elevated at 21 ng/ml. Prostate MRI reveals a globally enlarged prostate with a 3-cm nodule in the left median lobe with evidence of capsular invasion (PI-RADS 4). Biopsy reveals Gleason 4+3 disease in 5 of 12 core biopsies. Staging with PSMA PET scan shows 2 subcentimeter lesions in the bones (1 in the vertebrae and 1 in the left femur) as well as a 1.2-cm lesion in his left lung, all of which are consistent with metastatic disease. He is referred to you as part of a multidisciplinary evaluation considering treatment recommendations. He reports good urinary function; ECOG performance status is 0. Regarding this patient's goals of care, he would prefer to be “as aggressive as possible” with his treatment. |
| Oligorecurrent disease |
| A 65-year-old woman with a stage IIA colorectal adenocarcinoma (pT3N0M0) was treated with definitive surgical resection without adjuvant chemotherapy. Her baseline CEA was 10 ng/mg, with postsurgical CEA at 2 ng/mL. Ten months following surgery, she develops mild fatigue and a 5-pound weight loss, and is noted to have increasing CEA up to 12 ng/mL. Staging scans reveal metastatic disease in the lung (2 cm) and 2 sites in the liver (2 cm and 2.5 cm, respectively), but no concerning findings in the colon. Biopsy of one of the liver lesions revealed pathology consistent with metastatic disease of primary colorectal adenocarcinoma. ECOG performance status is 1. Regarding this patient's goals of care, she indicates she wishes to be aggressive in her cancer treatment to live as long as possible, but not at the expense of her quality of life. |
| Oligoprogressive disease |
| A 50-year-old man with limited smoking history is incidentally found to have a 2-cm mass in his RUL on a CT scan of his chest. Biopsy demonstrated lung adenocarcinoma without the presence of targetable mutations, such as EGFR mutation or ALK rearrangement. Staging scans reveal a 2-cm metastatic lesion to the contralateral pleura, multiple 1- to 1.5-cm liver lesions, and 2 subcentimeter brain metastases from which he is currently asymptomatic. Genetic profiling of the biopsy reveals PD-L1 expression of 10%. He is treated with combination chemotherapy and immunotherapy. Interval PET/CT scan shows marked reduction in the size and avidity of other sites of disease except in 2 of the 1- to 1.5-cm liver metastases, which have now both grown slightly to 1.6 and 1.8 cm with increasing avidity. He is referred to you as part of a multidisciplinary evaluation considering treatment recommendations. ECOG performance status is 1. His goal is to extend life as long as possible, even if it means he loses some quality of life. |
Abbreviations: ALK = anaplastic lymphoma kinase; CEA = carcinoembryonic antigen; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; EGFR = epidermal growth factor receptor; MRI = magnetic resonance imaging; PD-L1 = programmed death ligand 1; PET = positron emission tomography; PSA = prostate-specific antigen; PSMA = prostate-specific membrane antigen; RUL = right upper lobe.