What question did this study set out to answer?

Evaluate the impact of ablation on progression-free survival in patients with oligo-residual disease after EGFR-TKIs.

May 29, 2026

Ablation of oligo-residual disease to prolong progression-free survival in EGFR -mutant advanced NSCLC patients treated with third-generation EGFR-TKIs.

Key Points

Evaluate the impact of ablation on progression-free survival in patients with oligo-residual disease after EGFR-TKIs.
Retrospective enrollment of advanced NSCLC patients achieving oligo-residual disease post EGFR-TKI therapy.
Ablation techniques, including radiofrequency ablation and cryoablation, were performed on residual lung lesions.
Propensity score matching to compare ablation plus TKIs against TKIs monotherapy.
41% disease progression or death in the TKIs plus ablation group compared to 83% in the TKIs group.
Significant improvement in PFS (median 31.6 vs. 17.9 months; HR 0.36, 95% CI 0.26-0.51; p < 0.001).
Two-year PFS rates were 66.1% for the ablation group vs. 32.5% for the TKIs group.

Abstract

8633 Background: Combination of EGFR-TKIs with chemotherapy or amivantamab have become the standard of care for EGFR-mutant NSCLC. This study further evaluated the efficacy of ablation in advanced NSCLC patients who develop oligo-residual disease (ORD) after EGFR-TKI. Methods: We retrospectively enrolled patients with advanced NSCLC who achieved ORD after first-line third-generation EGFR TKIs therapy in Shanghai Pulmonary Hospital, Tongji University. Ablation, including radiofrequency ablation (RFA) and cryoablation, were administered for residual lung lesions. Using propensity score matching, patients with ORD who received TKIs monotherapy alone were set as the control group. The primary endpoint was progression-free survival (PFS). Results: From Jan 2019 to Dec 2023, a total of 292 patients (100 for TKIs plus ablation group and 192 for TKIs group) were included. With a median follow-up of 26.4 months, disease progression or death had occurred in 41 patients (41%) in the TKIs plus ablation group versus 159 patients (83%) in the TKIs group. The addition of ablation significantly improved PFS compared to TKIs alone (median 31.6 vs. 17.9 months; HR 0.36, 95% CI 0.26-0.51; p < 0.001). The 2-year PFS rate were 66.1% and 32.5%, respectively. A consistent trend was observed for overall survival (OS) (median OS: not reached; HR 0.36, 95% CI 0.20-0.65; p < 0.001). A total of 81 patients (22 for ablation group and 59 for TKIs group) underwent biopsies and NGS testing after resistance. The ablation group showed an increased incidence of MET amplification (17% vs. 7%) and HER2 amplification (8% vs. 4%), while on-target EGFR resistance mutations (C797S mutation or EGFR amplification) were similar. The side effects were similar in the two groups. Conclusions: Front-line third-generation EGFR-TKI combined with ablation for ORD led to significantly longer PFS than EGFR-TKIs alone in patients with advanced NSCLC, which provide an alternative strategy as the front line setting and warranting further prospective validation.

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