Local ablative treatment for oligoprogression during immunotherapy in metastatic non-small-cell lung cancer: a systematic review and meta-analysis

Some patients with metastatic non-small-cell lung cancer (NSCLC) receiving anti-PD-1 or anti-PD-L1 immune checkpoint inhibitors (ICIs) progress at a few sites while disease elsewhere stays controlled, a pattern consistent with focal, oligo-acquired immune escape rather than systemic treatment failure. Ablating the escaping focus may eliminate the resistant clone and preserve an otherwise effective immunotherapy line. We performed a PRISMA 2020-compliant, PROSPERO-registered systematic review and meta-analysis of local ablative treatment (LAT) for oligoprogressive or oligo-resistant metastatic NSCLC during active ICI therapy, with continuation of the same immunotherapy line after LAT. MEDLINE, PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to March 8, 2026. From 1270 records, 22 studies were included in the qualitative synthesis. Four studies, one randomized subgroup, and three retrospective cohorts contributed to each primary analysis. LAT-oriented management was associated with improved progression-free survival (PFS; pooled hazard ratio [HR] 0.45, 95% CI 0.33–0.62; 95% prediction interval [PI] 0.28–0.74; I2 = 0%) and overall survival (OS; pooled HR 0.41, 95% CI 0.27–0.63; 95% PI 0.24–0.69; I2 = 0%). PFS and OS estimates were consistent across sensitivity analyses, including the exclusion of the one PFS estimate measured to a second progression. The evidence is predominantly observational and of low certainty, reflecting the current absence of NSCLC-specific randomized trials. On this evidence, LAT, delivered predominantly as stereotactic body radiotherapy, may be considered a continuation-enabling option for carefully selected patients with focal progression on otherwise effective immunotherapy, pending ongoing randomized trials.