Efficacy of local therapy for oligoprogressive disease after PD-1 blockade in advanced non-small cell lung cancer

Abstract

Immune checkpoint inhibitors (ICIs) have dramatically changed the treatment strategy used for patients with non-small cell lung cancer (NSCLC); however, the vast majority of patients eventually develop progressive disease and acquire resistance to ICIs. Some patients experience oligoprogressive disease. Few retrospective studies have evaluated clinical efficacy in patients with oligometastatic progression who underwent local therapy after ICI treatment. We conducted a retrospective analysis of advanced NSCLC patients who underwent PD-1 inhibitor monotherapy with nivolumab or pembrolizumab to evaluate the effects of ICIs on the patterns of progression and the efficacy of local therapy for oligoprogressive diseases. Of the 307 patients treated with ICIs, 148 patients were evaluable in our cohort; 42 patients were treated with pembrolizumab, and 106 patients were treated with nivolumab. Thirty-eight patients showed oligoprogression. Male gender, a lack of driver mutations and smoking history were significantly correlated with the risk of oligoprogression. Primary lesions were most frequently detected at oligoprogression sites (15 patients), and 6 patients experienced abdominal lymph node (LN) oligoprogression. Four patients showed evidence of new abdominal LN oligometastases. There was no significant difference in overall survival between the local therapy group and the switch therapy group (reached vs not reached, P=0.456). The results may help to elucidate the causes ICI resistance and indicate that the use of local therapy as the initial treatment in this setting may be feasible.