Combination of Stereotactic Ablative Radiotherapy and Systemic Therapy in Oligoprogressive Non-small Cell Lung Cancer

Targeted therapy (TT) and immune checkpoint inhibitors (ICI) have significantly increased survival in metastatic non-small cell lung cancer (NSCLC). The development of acquired resistances to these treatments has led the way for a new clinical scenario: oligoprogressive disease (OPD). In this context, stereotactic ablative radiotherapy (SABR) has appeared as one promising strategy to overcome these resistances. This review aims to assess the current evidence on the role of SABR in oligoprogressive NSCLC. SABR in OPD is safe and seems to be effective for eradicating resistant tumor clones, allowing for the continuation of the same systemic line and with a possible impact in survival. The most solid evidence at the moment centers around the combination of SABR with TT, particularly in patients with EGFR and ALK mutations. SABR in combination with ICI is also a promising field which is exponentially growing. The ability to maintain the same systemic treatment after OPD seems to be relevant, given that it allows for a continued clinical benefit and extended survival in metastatic NSCLC. The use of SABR in this setting is showing promising results in early studies. This strategy should be further investigated in randomized trials to confirm this benefit and improve patient selection and treatment optimization.