Mohammed Abdulhaleem1,2, Hannah Johnston3, Ralph D'Agostino4, Claire Lanier3, Michael LeCompte5, Christina K Cramer3, Jimmy Ruiz6, Thomas Lycan6, Hui-Wen Lo7, Kuonosuke Watabe7, Stacey O'Neill8, Christopher Whitlow9, Jaclyn J White10, Stephen B Tatter10, Adrian W Laxton10, Jing Su11, Michael D Chan3. 1. Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. mabdulha@wakehealth.edu. 2. Department of Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA. mabdulha@wakehealth.edu. 3. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 4. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA. 5. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA. 6. Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 7. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 8. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 9. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 10. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. 11. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA.
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.
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.
Authors: Claire M Lanier; Ryan Hughes; Tamjeed Ahmed; Michael LeCompte; Adrianna H Masters; William J Petty; Jimmy Ruiz; Pierre Triozzi; Jing Su; Stacy O'Neill; Kuonosuke Watabe; Christina K Cramer; Adrian W Laxton; Stephen B Tatter; Ge Wang; Christopher Whitlow; Michael D Chan Journal: Neurooncol Pract Date: 2019-02-05