Oligoprogressive Non-Small-Cell Lung Cancer under Treatment with PD-(L)1 Inhibitors

Area of Science:

• Oncology
• Immunotherapy
• Non-small-cell lung cancer (NSCLC) research

Background:

• Oligoprogression (OPD) is a pattern of limited metastatic spread in cancer.
• Targeted therapies (TKI) for NSCLC are associated with OPD in about half of patients.
• The behavior of OPD under immunotherapy (IO) for NSCLC requires characterization.

Purpose of the Study:

• To characterize oligoprogression (OPD) patterns in non-small-cell lung cancer (NSCLC) patients treated with PD-1/PD-L1 inhibitors or chemoimmunotherapy.
• To compare OPD characteristics between IO and TKI treatments.
• To evaluate the prognostic implications of OPD under IO.

Main Methods:

• Retrospective analysis of 297 patients on IO monotherapy and 75 on chemoimmunotherapy.
• Comparison of OPD incidence, timing, affected sites, and lesion count.
• Analysis of survival outcomes and correlation with PD-L1 expression.

Main Results:

• OPD was more frequent (20% vs 10%), later (11 vs 5 months), and involved fewer sites/lesions under IO monotherapy compared to later lines.
• Mediastinal lymph nodes (42%) and brain (39%) were the most common sites of OPD.
• OPD under IO was associated with longer survival (26 vs 13 months) and higher PD-L1 expression compared to multifocal progression.

Conclusions:

• NSCLC oligoprogression is less common but more favorable under immunotherapy (IO) than targeted therapy (TKI).
• The incidence of OPD decreases in later treatment lines.
• Regular restaging and multidisciplinary assessment are essential for managing NSCLC oligoprogression effectively.