Local ablative treatment for oligoprogression during immunotherapy in metastatic non-small-cell lung cancer: a systematic review and meta-analysis
In brief
Local ablation during immunotherapy linked to 55% lower progression hazard
In pooled analyses, patients with metastatic lung cancer who received local treatment for a few progressing sites while continuing immunotherapy had about half the progression hazard and a 59% lower death hazard than comparison patients. The review included 22 studies, but only four contributed to each main analysis; mostly observational, low-certainty evidence leaves the benefit uncertain pending randomized trials.
- Journal
- Oncoimmunology (Q1)
- Published
- 31 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ismaell Massalha, Adham Hijab, Reem Zabit, Jamal Zidan, Ory Wiesel, Nir Peled
- PMID
- 42965526
- DOI
- 10.1080/2162402X.2026.2756061
Why clinicians should know about it
- Picked for Radiation Oncology (top studies of the week, 1 November 2026): Evaluates SBRT-led local ablation for oligoprogression during immunotherapy
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.