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Adrenal Oligoprogression — SCE Medical Oncology MCQ

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ModerateLung CancerAdrenal OligoprogressionSCE Medical Oncology

A 68-year-old man with metastatic NSCLC on pembrolizumab has been stable for 18 months. His PD-L1 was TPS 70% at diagnosis. He develops a new solitary adrenal metastasis while all other sites remain controlled. What is the preferred management approach?

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Correct answer: E — Continue pembrolizumab and consider local ablative therapy (SABR or adrenalectomy) to the adrenal oligoprogressive site

Oligoprogression (isolated progression at 1-2 sites on otherwise effective systemic therapy) is increasingly managed with 'treat-through' approaches: continue effective systemic therapy + add local ablative treatment (SABR, surgery, ablation) to the progressive site(s). This extends time on current therapy, delays more toxic alternatives, and is supported by the SABR-COMET and retrospective data. Adrenal metastases are particularly amenable to SABR or laparoscopic adrenalectomy.

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