Prior work has suggested that local therapy may provide a benefit to patients with oligoprogressive disease on other systemic therapies. Oftentimes, the oncological care team must weigh whether to change such a patient’s systemic therapy or selectively treat the refractory clones (with local therapy) while maintaining the current ICI. The optimal management of patients with oligoprogression is unclear. Regardless of PFS, however, overall survival in this population appears to be excellent. These results suggest that RT may provide a PFS benefit and extend the lifespan of ICIs in patients who experience oligoprogression. While 17 patients subsequently progressed, 15 did so at three or fewer metastatic sites and could have theoretically stood to benefit from an additional course of salvage RT to further extend the lifespan of their ICIs. The median progression-free survival (PFS) after RT was 7.1 months, and the time to oligoprogression was not a significant predictor of PFS2. The median radiation dose delivered was 4650 cGy in a median of five fractions.
24 patients had one oligoprogressive lesion and six had two. The median time to oligoprogression was 11.1 months from the initiation of immunotherapy. In this study, oligoprogression was defined as having experienced progression at three or fewer metastatic sites outside of the brain after achieving at least stable disease on ICIs for a minimum of three months.
We analyzed 30 patients with advanced solid tumors, the majority of whom (23/30, 86.7%) had either hepatocellular or urothelial carcinoma, who experienced oligoprogression on ICIs and were referred for RT. The benefit of ablative radiation therapy (RT) directed at these clones, as opposed to changing systemic therapy, is unclear. The breakthrough of a limited number of clones while on immune checkpoint inhibitors (ICIs), known as oligoprogression, has been previously described.
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