Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
J Neurooncol. 2022 Jul;158(3):481-488. doi: 10.1007/s11060-022-04038-z. Epub 2022 May 31.
The treatment of brain metastases with stereotactic radiosurgery (SRS) in combination with immune checkpoint inhibitors (ICI) has become more common in recent years, but there is a lack of prospective data on cancer control outcomes when these therapies are administered concurrently.
Data were retrospectively reviewed for patients with non-small cell lung cancer (NSCLC) and melanoma brain metastases treated with SRS at a single institution from May 2008 to January 2017. A parametric proportional hazard model is used to detect the effect of concurrent ICI within 30, 60, or 90 days of ICI administration on local control and distant in-brain control. Other patient and lesion characteristics are treated as covariates and adjusted in the regression. A frailty term is added in the baseline hazard to capture the within-patient correlation.
We identified 144 patients with 477 total lesions, including 95 NSCLC patients (66.0%), and 49 (34.0%) melanoma patients. On multivariate analysis, concurrent SRS and ICI (SRS within 30 days of ICI administration) was not associated with local control but was associated with distant brain control. When controlling for prior treatment to lesion, number of lesions, and presence of extracranial metastases, patients receiving this combination had a statistically significant decrease in distant brain failure compared to patients that received non-concurrent ICI or no ICI (HR 0.15; 95% CI 0.05-0.47, p = 0.0011).
Concurrent ICI can enhance the efficacy of SRS. Prospective studies would allow for stronger evidence to support the impact of concurrent SRS and ICI on disease outcomes.
近年来，立体定向放射外科（SRS）联合免疫检查点抑制剂（ICI）治疗脑转移瘤变得越来越普遍，但当这些治疗方法同时使用时，关于癌症控制结果的前瞻性数据仍然缺乏。
回顾性分析了 2008 年 5 月至 2017 年 1 月在一家机构接受 SRS 治疗的非小细胞肺癌（NSCLC）和黑色素瘤脑转移患者的数据。使用参数比例风险模型来检测 ICI 给药后 30、60 或 90 天内同时使用 ICI 对局部控制和远处脑内控制的影响。其他患者和病变特征被视为协变量，并在回归中进行调整。在基线风险中添加脆弱性项以捕获患者内相关性。
我们确定了 144 名患者，共 477 个病灶，包括 95 名 NSCLC 患者（66.0%）和 49 名黑色素瘤患者（34.0%）。在多变量分析中，SRS 和 ICI 的同时使用（ICI 给药后 30 天内的 SRS）与局部控制无关，但与远处脑控制有关。在控制病变、病灶数量和颅外转移存在之前的治疗后，与接受非同时 ICI 或无 ICI 的患者相比，接受这种联合治疗的患者远处脑失败的风险显著降低（HR 0.15；95%CI 0.05-0.47，p=0.0011）。
同时使用 ICI 可以增强 SRS 的疗效。前瞻性研究将允许提供更强有力的证据来支持 SRS 和 ICI 的同时使用对疾病结果的影响。
