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11 October 2022

In the Netherlands, routine follow-up of lung cancer patients consists of chest computed tomography (CT) scans every 3-6 months for the first 2 years and then yearly CT scans until 5 years of follow-up.1 With this one-size-fits-all approach, local recurrences can be detected but the risk of distant recurrence is much higher. Therefore, metastases often develop outside the scope of the scan.2

Furthermore, this approach was introduced before potentially survival prolonging treatments in oligometastatic (up to 5-10 metastases) patients became available.3–5  Therefore, improvement of follow-up care, by depicting the right follow-up frequency and the most optimal imaging modality per patient, is necessary to timely detect (oligometastatic) disease recurrence at a stage where effective and even curative-intent treatment is still possible. The presence of (Patient reported outcome (PRO)) symptoms prior to the detection of disease recurrence offers opportunities for patient participation and thus personalized follow-up strategies.

Project aim

With the Young Investigator Grant from KWF, Iris Walraven and her colleagues aim at developing a risk-stratified approach to follow-up care after curative-intent treatment in lung cancer patients. In this approach, the timing of the next follow-up visit and type of imaging modality is personalized to a patient’s risk of developing local or distant metastasis. To meet this aim, they will combine two important research areas that jointly could play an important role in optimizing follow-up care for lung cancer patients:

  1. The use of PROs during follow-up has recently shown to prolong overall survival (OS) in several cancer types, by early detection of symptomatic recurrence and treatment-related side effects.
  2. Artificial Intelligence algorithms have great potential in using dynamic longitudinal information to improve predictive models. Therefore, these algorithms could optimize follow-up care by identifying early changes indicative for recurrence development.

Both PRO symptom monitoring and the use of AI to personalize follow-up care are still relatively new research areas that are, up until now, not combined. By using sophisticated AI methods, the researchers will unravel the potential synergy between PRO symptoms and local or distant recurrence risk to move towards risk-stratified follow-up care in lung cancer patients. Furthermore, a mixed-methods study will be performed amongst end users (patients and healthcare practitioners) to identify needs and preferences for adopting and implementing a risk-stratified follow-up care approach.

About the KWF Young Investigator Grant

KWF offers young researchers the opportunity to initiate an independent oncological research line. Talented young researchers have the opportunity to submit their research proposals, which are reviewed in a separate competition known as the “Young Investigator Grant” (YIG).

The Young Investigator Grant is intended as a stepping stone for young researchers towards their own niche within the field of oncological research. The review procedure involves an interview to review whether the candidate is capable of taking on the responsibilities of a project leader and carrying out the project independently.

References

1.           NVALT. Richtlijn Niet-kleincellig longcarcinoom. https://www.nvalt.nl/kwaliteit/richtlijnen/oncologie/_/Oncologie/Richtlijn%20Niet-kleincellig%20longcarcinoom%20-%20modules%20set%202%20%20%20%202020.pdf.

2.           Stirling RG, Chau C, Shareh A, Zalcberg J, Fischer BM. Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis. Journal of Thoracic Oncology. 2021;16(5):784-797. doi:10.1016/j.jtho.2021.01.1622

3.           Iyengar P, Wardak Z, Gerber DE, et al. Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2018;4(1):e173501-e173501. doi:10.1001/jamaoncol.2017.3501

4.           Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. The Lancet. 2019;393(10185):2051-2058. doi:10.1016/S0140-6736(18)32487-5

5.           Gomez DR, Tang C, Zhang J, et al. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol. 2019;37(18):1558-1565. doi:10.1200/JCO.19.00201