[Therapeutic options for oligoprogressive non-small cell lung cancer]

Area of Science:

• Oncology
• Medical Physics

Background:

• Lung cancer remains a leading cause of cancer mortality, often diagnosed at a metastatic stage.
• Recent advances include anti-PD-(L)1 immunotherapies and targeted therapies for non-small cell lung cancer (NSCLC) with EGFR mutations or ALK rearrangements.
• Oligoprogression, a state of limited disease progression at specific sites while others remain controlled, represents a distinct clinical scenario.

Purpose of the Study:

• To evaluate the potential benefit of local ablative treatments for oligoprogressive NSCLC.
• To explore if local treatment can alter disease natural history and maintain systemic therapy efficacy.
• To assess the impact of aggressive local therapy on survival in oligoprogressive NSCLC patients.

Main Methods:

• Review of retrospective data on local ablative treatments (stereotactic radiotherapy, radiofrequency, mini-invasive surgery) in oligoprogressive NSCLC.
• Analysis of patient subgroups with limited progression during systemic treatment.
• Ongoing international clinical trials investigating radical local treatment for oligoprogressive advanced NSCLC.

Main Results:

• Current data supporting local treatment in oligoprogressive NSCLC are primarily retrospective and limited.
• Oligoprogressive lesions are characterized by a small number of progressing sites with other sites under control.
• Local treatment of oligoprogressive lesions may allow for continued effective systemic therapy.

Conclusions:

• Local ablative treatment of oligoprogressive NSCLC is a potential strategy to improve outcomes.
• Further prospective data from ongoing trials are crucial to validate the clinical benefit of this approach.
• Aggressive local therapy may offer a way to modify the natural history and improve survival in select NSCLC patients.