Local Therapy for Oligoprogression and Consolidation in EGFR-Mutant NSCLC

Julia Rotow, MD, of Dana-Farber Cancer Institute, asks Ticiana Leal, MD, of Winship Cancer Institute of Emory University, how she uses local therapy for oligoprogression or consolidation in EGFR-mutant non–small cell lung cancer. Dr Leal says most of her patients now receive first-line combination regimens because of high-risk features such as TP53 co-mutation, L858R, central nervous system disease, or high disease burden, so she uses upfront consolidation less often. She still radiates oligometastatic progression when there are a limited number of sites and the disease biology favors it, but moves to second-line therapy when the cancer is marching along. Dr Rotow agrees, noting retrospective data suggest radiation to oligoprogressive sites can add 4 to 6 months or longer before a systemic change is needed. She says the progression-free survival signal from the NORTHSTAR study makes consolidation a question she now considers for every patient, while cautioning that long-term overall survival data are still needed.