In brief
- Of 198 patients with locally advanced NSCLC whose disease progressed during or after durvalumab following chemoradiotherapy, 41 received local ablative therapy alone for oligoprogressive disease at seven centres between 2016 and 2023.
- Median progression-free survival from the start of local ablative therapy was 11.0 months, and median overall survival was 18.7 months.
- At two years, 32.6% of patients were alive without progression and 46.1% were alive.
- In multivariable analysis, progression-free survival of at least 12 months from the start of durvalumab and the absence of brain metastases were each associated with longer progression-free and overall survival.
- The study was retrospective with a single treated cohort, and the authors call for prospective studies to validate the findings.
Study at a glance
- Design: Multicentre retrospective cohort, seven centres, 2016 to 2023
- Population: Locally advanced NSCLC with oligoprogression after chemoradiotherapy and at least one dose of durvalumab
- Oligoprogression: Five or fewer progressive sites across no more than three organs
- Cohort: 41 of 198 patients who progressed during or after durvalumab
- Treatment: Local ablative therapy alone, with curative intent, to all sites of progression: radiotherapy 71%, surgery with or without radiotherapy 27%, cryoablation 2%
- Progression-free survival: Median 11.0 months; 47.2% at one year and 32.6% at two years
- Overall survival: Median 18.7 months; 61.7% at one year and 46.1% at two years
- Not reported: In the abstract, toxicity of local ablative therapy, median follow-up, and systemic treatment given after local therapy
A median overall survival of 18.7 months from the start of local treatment
Measured with the Kaplan-Meier method from the first day of local ablative therapy in all 41 patients, median progression-free survival was 11.0 months (95% CI 7.9 to 36.7), and median overall survival was 18.7 months (95% CI 11.1 to not reached). At one year, 47.2% of patients were alive without progression and 61.7% were alive. The corresponding two-year rates were 32.6% and 46.1%.
The confidence intervals are wide, as expected from a cohort of 41 patients. The upper limit for median progression-free survival extends to 36.7 months, and the upper limit for median overall survival had not been reached at the time of analysis.
One in five patients who progressed after durvalumab received local treatment alone
The seven centres identified 198 patients whose disease progressed during or after durvalumab consolidation, and 41 of them received local ablative therapy as their only treatment for oligoprogressive disease. Oligoprogression was defined as no more than five progressive sites across no more than three organs, and every site of progression had to be treated with curative intent.
Radiotherapy at a radical dose was the most common modality, used in 71% of patients. A further 27% underwent surgery, with or without radiotherapy, and 2% received cryoablation.
A hazard ratio of 0.33 for death when progression-free survival on durvalumab lasted 12 months or more
In multivariable Cox models, patients whose progression-free survival from the start of durvalumab was 12 months or longer had a lower risk of death after local ablative therapy (HR 0.33, 95% CI 0.12 to 0.86; p = 0.023) and a lower risk of progression or death (HR 0.39, 95% CI 0.17 to 0.87; p = 0.022).
The absence of brain metastases was also associated with better outcomes, with hazard ratios of 0.30 for overall survival (95% CI 0.11 to 0.87; p = 0.026) and 0.43 for progression-free survival (95% CI 0.19 to 0.99; p = 0.049). The progression-free survival result for brain metastases lies close to the conventional threshold for significance, with an upper confidence limit of 0.99.
A single retrospective cohort with no comparison group
The series was assembled retrospectively from seven centres over eight years, and it includes no group of patients with oligoprogression who were managed with systemic therapy alone. The survival reported after local treatment therefore cannot be attributed to the treatment itself, because the 41 patients selected for it may have differed from the other 157 in ways a retrospective design cannot separate from any effect of treatment.
“In selected patients with oligo-PD after CRT and durvalumab, exclusive LAT may be feasible and associated with encouraging survival.”Pravisano et al., European Journal of Cancer (2026)
The authors state that prospective studies are needed to validate these findings. The two factors identified in the multivariable analysis, the duration of disease control on durvalumab and the presence of brain metastases, are both known before local treatment begins, and the study reports them as prognostic factors in this treated cohort.
Sources
- European Journal of Cancer. Radical local treatment for patients with NSCLC following oligoprogression after chemoradiation and durvalumab (2026-10-01). doi.org
Featuring Lung Summit faculty
This study was co-authored by Lung Summit faculty Andrea Filippi and Lizza Hendriks.
This article was produced independently by the Lung Summit editorial team, without industry funding or input.
