Updates on Radiotherapy and Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer

A large multinational retrospective cohort showed that radiotherapy plus immune checkpoint inhibitors to limited progressive sites can improve outcomes in oligoprogressive non–small cell lung cancer, including stronger local control of treated lesions and signals of prolonged downstream survival.

The analysis pooled real-world, multi-institutional data and focused on patients who received radiotherapy to oligoprogressive lesions while continuing ICI therapy. Local control (LC) of targeted lesions, progression-free survival (PFS), and overall survival (OS) were assessed with Kaplan–Meier estimates and Cox proportional-hazards modeling across centers.

Survival analyses demonstrated improved progression-free and overall survival when radiotherapy was delivered to oligoprogressive lesions during ongoing ICI therapy.

Local control of irradiated progressive lesions was high. Adjusted models identified a dose–outcome association: intermediate-to-high EQD2 regimens correlated with superior LC and a favorable survival signal (statistically significant in multivariable analyses). Reported toxicity was generally manageable, with few severe radiation-related events, supporting feasibility of higher ablative-equivalent dosing when anatomic constraints permit.

Taken together, these findings support considering focused radiotherapy as part of multidisciplinary management for selected patients with oligoprogressive non-small cell lung cancer. Intermediate-to-high EQD2 approaches may be reasonable for ablative intent in carefully selected cases, but prospective trials are needed to validate these retrospective associations and define optimal patient selection and dosing.