The impact of sequencing PD-1/PD-L1 inhibitors and stereotactic radiosurgery for patients with brain metastasis.

Neuro-oncology
Rupesh KotechaManmeet S Ahluwalia

Abstract

The response of brain metastases (BM) treated with stereotactic radiosurgery (SRS) and immune checkpoint inhibitors (ICIs; programmed cell death 1 and its ligand) is of significant interest. Patients were divided into cohorts based on ICI sequencing around SRS. The primary outcome was best objective response (BOR) that was lesion specific. Secondary outcomes included overall objective response (OOR), response durability, radiation necrosis (RN), and overall survival (OS). One hundred fifty patients underwent SRS to 1003 BM and received ICI. Five hundred sixty-four lesions (56%) treated with concurrent ICI (±5 half-lives) demonstrated superior BOR, OOR, and response durability compared with lesions treated with SRS and delayed ICI. Responses were best in those treated with immediate (±1 half-life) ICI (BOR: -100 vs -57%, P < 0.001; complete response: 50 vs 32%; 12-month durable response: 94 vs 71%, P < 0.001). Lesions pre-exposed to ICI and treated with SRS had poorer BOR (-45%) compared with ICI naive lesions (-63%, P < 0.001); best response was observed in ICI naive lesions receiving SRS and immediate ICI (-100%, P < 0.001). The 12-month cumulative incidence of RN with immediate ICI was 3.2% (95% CI: 1.3-5.0%). First radiograp...Continue Reading

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Citations

Apr 18, 2020·Neurosurgery·Elisa Aquilanti, Priscilla K Brastianos
Apr 18, 2020·Expert Review of Anticancer Therapy·Michael RuffJan Buckner
Jul 28, 2019·Journal of Neuro-oncology·Charissa A C JessurunMarike L D Broekman
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Jan 8, 2020·Cancers·Julijan KabiljoMichael Bergmann
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Jan 12, 2021·Human Vaccines & Immunotherapeutics·Chen ChenBinbin Cui
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Dec 10, 2021·Hematology/oncology and Stem Cell Therapy·Amir AnvariMania Rajabzadeh Kheradmardi

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