Daniel N Cagney1, Allison M Martin2, Paul J Catalano3, Zachary J Reitman2, Gabrielle A Mezochow2, Eudocia Q Lee4, Patrick Y Wen4, Stephanie E Weiss5, Paul D Brown6, Manmeet S Ahluwalia7, Nils D Arvold8, Shyam K Tanguturi2, Daphne A Haas-Kogan2, Brian M Alexander2, Amanda J Redig9, Ayal A Aizer2. 1. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA. Electronic address: dcagney@bwh.harvard.edu. 2. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA. 3. Department of Biostatistics, Harvard T. H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA. 4. Department of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA. 5. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA. 6. Department of Radiation Oncology, Mayo Clinic, Rochester, USA. 7. Department of Neuro-Oncology, Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, USA. 8. Department of Radiation Oncology, St. Luke's Radiation Oncology Associates, Duluth, USA. 9. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
Abstract
BACKGROUND: Pemetrexed is a folate antimetabolite used in the management of advanced adenocarcinoma of the lung. We sought to assess the impact of pemetrexed on intracranial disease control and radiation-related toxicity among patients with adenocarcinoma of the lung who received stereotactic radiation for brain metastases. MATERIALS/ METHODS: We identified 149 patients with adenocarcinoma of the lung and newly diagnosed brain metastases without a targetable mutation receiving stereotactic radiation. Kaplan-Meier plots and Cox regression were employed to assess whether use of pemetrexed was associated with intracranial disease control and radiation necrosis. RESULTS: Among the entire cohort, 105 patients received pemetrexed while 44 did not. Among patients who were chemotherapy-naïve, use of pemetrexed (n = 43) versus alternative regimens after stereotactic radiation (n = 24) was associated with a reduced likelihood of developing new brain metastases (HR 0.42, 95% CI 0.22-0.79, p = 0.006) and a reduced need for salvage brain-directed radiation therapy (HR 0.36, 95% CI 0.18-0.73, p = 0.005). Pemetrexed use was associated with increased radiographic necrosis. (HR 2.70, 95% CI 1.09-6.70, p = 0.03). CONCLUSIONS: Patients receiving pemetrexed after brain-directed stereotactic radiation appear to benefit from improved intracranial disease control at the possible expense of radiation-related radiographic necrosis. Whether symptomatic radiation injury occurs more frequently in patients receiving pemetrexed requires further study.
BACKGROUND:Pemetrexed is a folate antimetabolite used in the management of advanced adenocarcinoma of the lung. We sought to assess the impact of pemetrexed on intracranial disease control and radiation-related toxicity among patients with adenocarcinoma of the lung who received stereotactic radiation for brain metastases. MATERIALS/ METHODS: We identified 149 patients with adenocarcinoma of the lung and newly diagnosed brain metastases without a targetable mutation receiving stereotactic radiation. Kaplan-Meier plots and Cox regression were employed to assess whether use of pemetrexed was associated with intracranial disease control and radiation necrosis. RESULTS: Among the entire cohort, 105 patients received pemetrexed while 44 did not. Among patients who were chemotherapy-naïve, use of pemetrexed (n = 43) versus alternative regimens after stereotactic radiation (n = 24) was associated with a reduced likelihood of developing new brain metastases (HR 0.42, 95% CI 0.22-0.79, p = 0.006) and a reduced need for salvage brain-directed radiation therapy (HR 0.36, 95% CI 0.18-0.73, p = 0.005). Pemetrexed use was associated with increased radiographic necrosis. (HR 2.70, 95% CI 1.09-6.70, p = 0.03). CONCLUSIONS:Patients receiving pemetrexed after brain-directed stereotactic radiation appear to benefit from improved intracranial disease control at the possible expense of radiation-related radiographic necrosis. Whether symptomatic radiation injury occurs more frequently in patients receiving pemetrexed requires further study.
Authors: Rachel H Brigell; Daniel N Cagney; Allison M Martin; Luke A Besse; Paul J Catalano; Eudocia Q Lee; Patrick Y Wen; Paul D Brown; John G Phillips; Itai M Pashtan; Shyam K Tanguturi; Daphne A Haas-Kogan; Brian M Alexander; Ayal A Aizer Journal: J Neurooncol Date: 2019-02-04 Impact factor: 4.130
Authors: Pierre-Yves Borius; Jean Régis; Alexandre Carpentier; Michel Kalamarides; Charles Ambroise Valery; Igor Latorzeff Journal: Cancer Metastasis Rev Date: 2021-01-04 Impact factor: 9.264
Authors: Ayal A Aizer; Nayan Lamba; Manmeet S Ahluwalia; Kenneth Aldape; Adrienne Boire; Priscilla K Brastianos; Paul D Brown; D Ross Camidge; Veronica L Chiang; Michael A Davies; Leland S Hu; Raymond Y Huang; Timothy Kaufmann; Priya Kumthekar; Keng Lam; Eudocia Q Lee; Nancy U Lin; Minesh Mehta; Michael Parsons; David A Reardon; Jason Sheehan; Riccardo Soffietti; Hussein Tawbi; Michael Weller; Patrick Y Wen Journal: Neuro Oncol Date: 2022-10-03 Impact factor: 13.029
Authors: Thiago Pimentel Muniz; Victor Hugo Fonseca de Jesus; Victor Aurélio Ramos Sousa; Malu Viter da Rosa Barbosa; Vladmir Cláudio Cordeiro de Lima Journal: J Thorac Dis Date: 2019-09 Impact factor: 2.895