What is your preferred approach for managing oligoprogressive NSCLC during second-line or later systemic therapy if patient is otherwise responding well at other sites of disease?

I would offer metastasis-directed therapy with SBRT or if necessary based on site, hypofractionated (8-15 fractions) RT to oligoprogressive disease in this setting which we now have Phase 2 randomized data to support due to the nice work of Dr. @Dr. First Last and her team in the CURB trial. Patients with 1-5 oligoprogressive lesions from breast or NSCLC primary tumors were randomized to SOC vs local therapy with SBRT. ~25% of patients had a single lesion with 75% having 2-5 oligoprogressive lesions. Progression free survival benefit was observed in the cohort of patients overall (including both breast and lung primaries), however, this was exclusively driven by a benefit in patients with NSCLC demonstrating an increase in median PFS from 2...

First I should acknowledge that there is still a lack of consensus on the definition of oligoprogressive disease, and the definition of “second-line” could mean chemo after anti-PD(L)1, anti-PD-(L)1 after chemo, or post-chemoIO treatment. Generally, for patients with a predominant systemic response and few sites of progression, my approach is to continue the active systemic therapy and offer local therapy to progressing lesions as long as therapy remains well tolerated. In many clinical trials, it is common to permit local ablative therapy where clinically appropriate, with the caveat that target lesions per RECISTv1.1 often must remain untreated in order for study radiologists to be able to render meaningful assessments about disease respo...