Paolo Palmisciano1, Ali S Haider2, Chibueze D Nwagwu3, Waseem Wahood4, Kenny Yu5, Chibawanye I Ene6, Barbara J O'Brien7, Salah G Aoun8, Aaron A Cohen-Gadol9, Tarek Y El Ahmadieh10. 1. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy. 2. Texas A&M University College of Medicine, Houston, TX, U.S.A. 3. Emory University School of Medicine, Atlanta, GA, U.S.A. 4. Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL, U.S.A. 5. Department of Neurosurgical Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A. 6. Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, U.S.A. 7. Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, U.S.A. 8. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A. 9. Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, U.S.A. 10. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.; telahmadieh@gmail.com.
Abstract
BACKGROUND/AIM: Leptomeningeal disease (LMD) is a debilitating complication of advanced malignancies. Immune-checkpoint inhibitors (ICIs) may alter disease course. We analyzed the role and toxicity of ICIs in LMD. MATERIALS AND METHODS: We systematically reviewed the literature reporting on outcome data of patients with LMD treated with ICIs. RESULTS: We included 14 studies encompassing 61 patients. Lung-cancer (44.3%), breast-cancer (27.9%), and melanoma (23.0%) were the most frequent primary tumors. Median duration of ICI-treatment was 7-months (range=0.5-58.0): pembrolizumab (49.2%), nivolumab (32.8%), ipilimumab (18.0%). Radiological responses included complete response (33.3%), partial response (12.5%), stable disease (33.3%), progressive disease (20.8%). Twenty-two patients developed ICI-related adverse-events, mild (100%) and/or severe (15.6%). Median progression-free and overall survival were 5.1 and 6.3 months, and 12-month survival was 32.1%. Survival correlated with ICI agents (p=0.042), but not with primary tumors (p=0.144). Patients receiving concurrent steroids showed worse survival (p=0.040). CONCLUSION: ICI therapy is well-tolerated in patients with LMD, but concurrent steroids may worsen survival.
BACKGROUND/AIM: Leptomeningeal disease (LMD) is a debilitating complication of advanced malignancies. Immune-checkpoint inhibitors (ICIs) may alter disease course. We analyzed the role and toxicity of ICIs in LMD. MATERIALS AND METHODS: We systematically reviewed the literature reporting on outcome data of patients with LMD treated with ICIs. RESULTS: We included 14 studies encompassing 61 patients. Lung-cancer (44.3%), breast-cancer (27.9%), and melanoma (23.0%) were the most frequent primary tumors. Median duration of ICI-treatment was 7-months (range=0.5-58.0): pembrolizumab (49.2%), nivolumab (32.8%), ipilimumab (18.0%). Radiological responses included complete response (33.3%), partial response (12.5%), stable disease (33.3%), progressive disease (20.8%). Twenty-two patients developed ICI-related adverse-events, mild (100%) and/or severe (15.6%). Median progression-free and overall survival were 5.1 and 6.3 months, and 12-month survival was 32.1%. Survival correlated with ICI agents (p=0.042), but not with primary tumors (p=0.144). Patients receiving concurrent steroids showed worse survival (p=0.040). CONCLUSION: ICI therapy is well-tolerated in patients with LMD, but concurrent steroids may worsen survival.
Authors: Timothy K Nguyen; Arjun Sahgal; Jay Detsky; Eshetu G Atenafu; Sten Myrehaug; Chia-Lin Tseng; Zain Husain; Chris Heyn; Pejman Maralani; Mark Ruschin; James Perry; Hany Soliman Journal: Neuro Oncol Date: 2020-01-11 Impact factor: 12.300
Authors: Kim Margolin; Marc S Ernstoff; Omid Hamid; Donald Lawrence; David McDermott; Igor Puzanov; Jedd D Wolchok; Joseph I Clark; Mario Sznol; Theodore F Logan; Jon Richards; Tracy Michener; Agnes Balogh; Kevin N Heller; F Stephen Hodi Journal: Lancet Oncol Date: 2012-03-27 Impact factor: 41.316