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Oligoprogression — SCE Medical Oncology MCQ

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HardMelanoma & SkinOligoprogressionSCE Medical Oncology

A 70-year-old man with metastatic melanoma responds well to pembrolizumab but develops progressive isolated adrenal metastasis at month 8 while all other sites remain controlled. The adrenal metastasis is 3 cm on imaging. What approach should be considered?

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Correct answer: B — Continue pembrolizumab and add stereotactic ablative radiotherapy (SABR) or adrenalectomy to the oligoprogressive site

Oligoprogression management (continuing effective systemic therapy + local ablative treatment to the limited progressive site) is increasingly practised in melanoma and other tumour types. The SABR-COMET trial demonstrated OS benefit for ablative treatment of oligometastatic/oligoprogressive sites. Laparoscopic adrenalectomy or SABR to an isolated adrenal metastasis can achieve local control while preserving the systemic benefit of ongoing immunotherapy.

Reference: ESMO 2024 Melanoma Guidelines; SABR-COMET Palma et al Lancet 2019