Local Therapy for Oligoprogressive Disease: A Systematic Review of Prospective Trials
Abstract
OBJECTIVES
The successes of local therapy for oligometastatic cancers cannot be extrapolated to oligoprogressive disease (OPD) because they are distinct clinical entities. Given the limited prospective data on OPD to date, summative analyses are urgently needed.
METHODS
Inclusion criteria for this PRISMA-guided systematic review were as follows. First, only prospective data were included. Second, progression had to have occurred on active/ongoing systemic therapy. Third, the number of progressing areas of disease had to be explicitly listed and ≤5 in number. Fourth, all progressing sites had to undergo local therapy (radiotherapy/surgery/non-radiation ablative procedures).
RESULTS
Eight trials met criteria (summing 290 patients), the vast majority of which utilized stereotactic radiotherapy as the local modality (most commonly, 19-20 Gy in 1 fraction, 27-33 Gy in 3 fractions, or 35-50 Gy in 5 fractions). A study on NSCLC demonstrated that stereotactic radiotherapy improved progression-free survival (PFS) and overall survival compared to historical values with systemic therapy alone. Two additional studies on EGFR-mutated NSCLC also showed acceptable PFS with local therapy, particularly in patients who oligoprogressed on osimertinib. The only randomized trial analyzed herein showed that local therapy improved PFS for NSCLC but not breast cancer. Two trials in castration-resistant prostate cancer illustrated that a substantial proportion of patients did not require any changes…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 290 participants or records.
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