دورية أكاديمية
أعرض في EDS

Long-Term Intracranial Outcomes With Combination Dual Immune-Checkpoint Blockade and Stereotactic Radiosurgery in Patients With Melanoma and Non-Small Cell Lung Cancer Brain Metastases.

التفاصيل البيبلوغرافية
العنوان: Long-Term Intracranial Outcomes With Combination Dual Immune-Checkpoint Blockade and Stereotactic Radiosurgery in Patients With Melanoma and Non-Small Cell Lung Cancer Brain Metastases.
المؤلفون: Vaios EJ; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Shenker RF; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Hendrickson PG; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Wan Z; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina., Niedzwiecki D; Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina., Winter SF; Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts., Shih HA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts., Dietrich J; Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts., Wang C; Departments of Medical Physics, Duke University Medical Center, Durham, North Carolina., Salama AKS; Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina., Clarke JM; Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina., Allen K; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Sperduto P; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Mullikin T; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Kirkpatrick JP; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Neurosurgery, Duke University Medical Center, Durham, North Carolina., Floyd SR; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina., Reitman ZJ; Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Neurosurgery, Duke University Medical Center, Durham, North Carolina; Pathology, Duke University Medical Center, Durham, North Carolina. Electronic address: zjr@duke.edu.
المصدر: International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2024 Apr 01; Vol. 118 (5), pp. 1507-1518. Date of Electronic Publication: 2023 Dec 12.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier, Inc Country of Publication: United States NLM ID: 7603616 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-355X (Electronic) Linking ISSN: 03603016 NLM ISO Abbreviation: Int J Radiat Oncol Biol Phys Subsets: MEDLINE
أسماء مطبوعة: Publication: New York, NY : Elsevier, Inc
Original Publication: Elmsford, N. Y., Pergamon Press.
مواضيع طبية MeSH: Carcinoma, Non-Small-Cell Lung*/radiotherapy , Melanoma*/radiotherapy , Radiosurgery*/methods , Lung Neoplasms*/radiotherapy , Lung Neoplasms*/etiology , Brain Neoplasms*/secondary, Humans ; Immune Checkpoint Inhibitors ; Retrospective Studies
مستخلص: Purpose: The intracranial benefit of offering dual immune-checkpoint inhibition (D-ICPI) with ipilimumab and nivolumab to patients with melanoma or non-small cell lung cancer (NSCLC) receiving stereotactic radiosurgery (SRS) for brain metastases (BMs) is unknown. We hypothesized that D-ICPI improves local control compared with SRS alone.
Methods and Materials: Patients with melanoma or NSCLC treated with SRS from 2014 to 2022 were evaluated. Patients were stratified by treatment with D-ICPI, single ICPI (S-ICPI), or SRS alone. Local recurrence, intracranial progression (IP), and overall survival were estimated using competing risk and Kaplan-Meier analyses. IP included both local and distant intracranial recurrence.
Results: Two hundred eighty-eight patients (44% melanoma, 56% NSCLC) with 1,704 BMs were included. Fifty-three percent of patients had symptomatic BMs. The median follow-up was 58.8 months. Twelve-month local control rates with D-ICPI, S-ICPI, and SRS alone were 94.73% (95% CI, 91.11%-96.90%), 91.74% (95% CI, 89.30%-93.64%), and 88.26% (95% CI, 84.07%-91.41%). On Kaplan-Meier analysis, only D-ICPI was significantly associated with reduced local recurrence (P = .0032). On multivariate Cox regression, D-ICPI (hazard ratio [HR], 0.4003; 95% CI, 0.1781-0.8728; P = .0239) and planning target volume (HR, 1.022; 95% CI, 1.004-1.035; P = .0059) correlated with local control. One hundred seventy-three (60%) patients developed IP. The 12-month cumulative incidence of IP was 41.27% (95% CI, 30.27%-51.92%), 51.86% (95% CI, 42.78%-60.19%), and 57.15% (95% CI, 44.98%-67.59%) after D-ICPI, S-ICPI, and SRS alone. On competing risk analysis, only D-ICPI was significantly associated with reduced IP (P = .0408). On multivariate Cox regression, D-ICPI (HR, 0.595; 95% CI, 0.373-0.951; P = .0300) and presentation with >10 BMs (HR, 2.492; 95% CI, 1.668-3.725; P < .0001) remained significantly correlated with IP. The median overall survival after D-ICPI, S-ICPI, and SRS alone was 26.1 (95% CI, 15.5-40.7), 21.5 (16.5-29.6), and 17.5 (11.3-23.8) months. S-ICPI, fractionation, and histology were not associated with clinical outcomes. There was no difference in hospitalizations or neurologic adverse events between cohorts.
Conclusions: The addition of D-ICPI for patients with melanoma and NSCLC undergoing SRS is associated with improved local and intracranial control. This appears to be an effective strategy, including for patients with symptomatic or multiple BMs.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: K08 CA256045 United States CA NCI NIH HHS; R38 CA245204 United States CA NCI NIH HHS
المشرفين على المادة: 0 (Immune Checkpoint Inhibitors)
تواريخ الأحداث: Date Created: 20231214 Date Completed: 20240318 Latest Revision: 20240430
رمز التحديث: 20240430
مُعرف محوري في PubMed: PMC11056239
DOI: 10.1016/j.ijrobp.2023.12.002
PMID: 38097090
قاعدة البيانات: MEDLINE
الوصف
تدمد:1879-355X
DOI:10.1016/j.ijrobp.2023.12.002