Local ablative treatment for oligoprogression during immunotherapy in metastatic non-small-cell lung cancer: a systematic review and meta-analysis
6 affiliations
- 1Department of Radiation Oncology, Ziv Medical Center, Safed, Israel
- 2Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- 3Department of Pediatrics, Ziv Medical Center, Safed, Israel
- 4Department of Oncology, Ziv Medical Center, Safed, Israel
- 5Baruch Padeh-Tzafon Medical Center, Poriya, Israel
- 6Helmsley Cancer Center, Shaare Zedek Medical Center, Jerusalem, Israel
Abstract
Some patients with metastatic non-small-cell lung cancer (NSCLC) receiving anti-PD-1 or anti-PD-L1 immune checkpoint inhibitors (ICIs) progress at a few sites while disease elsewhere stays controlled, a pattern consistent with focal, oligo-acquired immune escape rather than systemic treatment failure. Ablating the escaping focus may eliminate the resistant clone and preserve an otherwise effective immunotherapy line. We performed a PRISMA 2020-compliant, PROSPERO-registered systematic review and meta-analysis of local ablative treatment (LAT) for oligoprogressive or oligo-resistant metastatic NSCLC during active ICI therapy, with continuation of the same immunotherapy line after LAT. MEDLINE, PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to March 8, 2026. From 1270 records, 22 studies were included in the qualitative synthesis. Four studies, one randomized subgroup, and three retrospective cohorts contributed to each primary analysis. LAT-oriented management was associated with improved progression-free survival (PFS; pooled hazard ratio [HR] 0.45, 95% CI 0.33–0.62; 95% prediction interval [PI] 0.28–0.74; I2 = 0%) and overall survival (OS; pooled HR 0.41, 95% CI 0.27–0.63; 95% PI 0.24–0.69; I2 = 0%). PFS and OS estimates were consistent across sensitivity analyses, including the exclusion of the one PFS estimate measured to a second progression. The evidence is predominantly observational and of low certainty, reflecting the current absence of NSCLC-specific randomized trials. On this evidence, LAT, delivered predominantly as stereotactic body radiotherapy, may be considered a continuation-enabling option for carefully selected patients with focal progression on otherwise effective immunotherapy, pending ongoing randomized trials.
Related
- Immunotherapy with Pembrolizumab beyond Progression and Local Ablative Therapy in Oligoprogressive Metastatic Non-Small Cell Lung Cancer
- 1105 HER3 inhibition sensitizes metastatic colorectal and pancreatic cancer to immunotherapy
- 1189 A phase 1/1b study of the tumor-activated IL-2 prodrug WTX-124 alone or in combination with pembrolizumab in adults with relapsed/refractory, advanced/metastatic, immunotherapy-sensitive solid tumors
- Explainable machine learning to predict immunotherapy outcomes in metastatic renal cell carcinoma - Meet-URO 15-AI study
- Prediction of Pathological Complete Response to Neoadjuvant Immunotherapy-Based Regimens for Non-Metastatic Colon and Rectal Cancer
BibTeX
@article{massalha2026local,
title = {{Local ablative treatment for oligoprogression during immunotherapy in metastatic non-small-cell lung cancer: a systematic review and meta-analysis}},
author = {Ismaell Massalha and Adham Hijab and Reem Zabit and Jamal Zidan and Ory Wiesel and Nir Peled},
journal = {Oncoimmunology},
year = {2026},
month = oct,
doi = {10.1080/2162402x.2026.2756061},
url = {https://doi.org/10.1080/2162402x.2026.2756061},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Local ablative treatment for oligoprogression during immunotherapy in metastatic non-small-cell lung cancer: a systematic review and meta-analysis
AU - Ismaell Massalha
AU - Adham Hijab
AU - Reem Zabit
AU - Jamal Zidan
AU - Ory Wiesel
AU - Nir Peled
PY - 2026
DA - 2026/10/31
JO - Oncoimmunology
DO - 10.1080/2162402x.2026.2756061
UR - https://doi.org/10.1080/2162402x.2026.2756061
AB - Some patients with metastatic non-small-cell lung cancer (NSCLC) receiving anti-PD-1 or anti-PD-L1 immune checkpoint inhibitors (ICIs) progress at a few sites while disease elsewhere stays controlled, a pattern consistent with focal, oligo-acquired immune escape rather than systemic treatment failure. Ablating the escaping focus may eliminate the resistant clone and preserve an otherwise effective immunotherapy line. We performed a PRISMA 2020-compliant, PROSPERO-registered systematic review and meta-analysis of local ablative treatment (LAT) for oligoprogressive or oligo-resistant metastatic NSCLC during active ICI therapy, with continuation of the same immunotherapy line after LAT. MEDLINE, PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to March 8, 2026. From 1270 records, 22 studies were included in the qualitative synthesis. Four studies, one randomized subgroup, and three retrospective cohorts contributed to each primary analysis. LAT-oriented management was associated with improved progression-free survival (PFS; pooled hazard ratio [HR] 0.45, 95% CI 0.33–0.62; 95% prediction interval [PI] 0.28–0.74; I2 = 0%) and overall survival (OS; pooled HR 0.41, 95% CI 0.27–0.63; 95% PI 0.24–0.69; I2 = 0%). PFS and OS estimates were consistent across sensitivity analyses, including the exclusion of the one PFS estimate measured to a second progression. The evidence is predominantly observational and of low certainty, reflecting the current absence of NSCLC-specific randomized trials. On this evidence, LAT, delivered predominantly as stereotactic body radiotherapy, may be considered a continuation-enabling option for carefully selected patients with focal progression on otherwise effective immunotherapy, pending ongoing randomized trials.
SN - 2162-4011
SN - 2162-402X
ER -