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Local control outcomes for combination of stereotactic radiosurgery and immunotherapy for non-small cell lung cancer brain metastases

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Abstract

Background

Previous series have demonstrated CNS activity for immune checkpoint inhibitors, yet no prior data exists regarding whether this activity can improve outcomes of stereotactic radiosurgery.

Methods

In this single institution retrospective series, the clinical outcomes of 80 consecutive lung cancer patients treated with concurrent immune checkpoint inhibitors and stereotactic radiosurgery were compared to 235 in the historical control cohort in which patients were treated prior to immune checkpoint inhibition being standard upfront therapy. Overall survival was estimated using the Kaplan Meier method. Cumulative incidence of local progression was estimated using a competing risk model.

Results

Median overall survival time was improved in patients receiving upfront immunotherapy compared to the historical control group (40 months vs 8 months, p < 0.001). Factors affected overall survival include concurrent immunotherapy (HR 0.23, p < 0.0001) and KPS (HR 0.97, p = 0.0001). Cumulative incidence of local failure in the historical control group was 10% at 1 year, compared to 1.1% at 1 year in the concurrent immunotherapy group (p = 0.025). Factors affected local control included use of concurrent immunotherapy (HR 0.09, p = 0.012), and lowest margin dose delivered to a metastasis (HR 0.8, p = 0.0018).

Conclusion

Local control and overall survival were both improved in patients receiving concurrent immune checkpoint inhibitors with radiosurgery compared to historical controls. While these data remain to be validated, they suggest that brain metastasis patients may benefit from concurrent use of immunotherapy with SRS.

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Author information

Authors and Affiliations

  1. Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Mohammed Abdulhaleem, Jimmy Ruiz & Thomas Lycan

  2. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Hannah Johnston, Claire Lanier, Christina K. Cramer & Michael D. Chan

  3. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Ralph D’Agostino Jr.

  4. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Michael LeCompte

  5. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Hui-Wen Lo & Kuonosuke Watabe

  6. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Stacey O’Neill

  7. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Christopher Whitlow

  8. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jaclyn J. White, Stephen B. Tatter & Adrian W. Laxton

  9. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA

    Jing Su

  10. Department of Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA

    Mohammed Abdulhaleem

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  1. Mohammed Abdulhaleem
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  2. Hannah Johnston
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Correspondence to Mohammed Abdulhaleem.

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Abdulhaleem, M., Johnston, H., D’Agostino, R. et al. Local control outcomes for combination of stereotactic radiosurgery and immunotherapy for non-small cell lung cancer brain metastases. J Neurooncol 157, 101–107 (2022). https://doi.org/10.1007/s11060-022-03951-7

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  • DOI: https://doi.org/10.1007/s11060-022-03951-7

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