Management of oligoprogressive and oligopersistent disease in advanced NSCLC

The oligometastatic disease state is defined as an intermediate state between localized cancer and widespread systemic metastases. Oligoprogression is defined as a subgroup in which limited metastatic areas are progressing in the background of oligometastatic or polymetastatic disease, whereas oligopersistent disease refers to an induced state in which formerly polymetastatic disease responds to treatment and decreases to fewer than 5 sites of active disease. With modern improvements in systemic therapy for patients with non-small cell lung cancer, including immunotherapies and targeted therapies, there may be a role for local therapy in selected patients with limited metastases-a subset of patients with potentially curable metastatic disease. Improved imaging techniques and advancements in highly conformal delivery of radiotherapy with stereotactic body radiation therapy have increased interest in using ablative radiotherapy or surgery as local consolidation therapy to improve patient outcomes. In this review, we define the oligoprogressive and oligopersistent disease states in patients with non-small cell lung cancer and discuss the evidence for the treatment and management of this patient population, including recent prospective trials and future directions in the selection of patients who will benefit most from local therapy.