Immunotherapy in association with stereotactic radiotherapy for non-small cell lung cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO

Scoccianti, Silvia; Olmetto, Emanuela; Pinzi, Valentina; Osti, Mattia Falchetto; Franco, Rossella Di; Caini, Saverio; Anselmo, Paola; Matteucci, Paolo; Franceschini, Davide; Mantovani, Cristina; Beltramo, G.; Pasqualetti, Francesco; Bruni, Alessio; Tini, Paolo; Giudice, Emilia; Ciammella, Patrizia; Merlotti, Anna; Pedretti, Sara; Trignani, Marianna; Krengli, Marco; Giaj-Levra, Niccolò; Desideri, Isacco; Pecchioli, Guido; Muto, Paolo; Maranzano, Ernesto; Fariselli, Laura; Navarria, Pierina; Ricardi, Umberto; Scotti, Vieri; Livi, Lorenzo

doi:10.1093/neuonc/noab129

Cited by 32 publications

(28 citation statements)

References 44 publications

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“…Similarly, a multicentric retrospective study from AIRO (Italian Association of Radiotherapy and Clinical Oncology) for patients with brain metastases from NSCLC reported that patients with the interval between SBRT and IO ≤ 7 days had a longer survival compared with the interval between SBRT and IO > 7 days. 413 This study data supports the delivery of SBRT and IO within a short time frame given that concurrent therapy is shown to be more effective without having an impact on toxicity. In conclusion, these data from clinical trials and retrospective studies indicate that concurrent iRT may be more effective than sequential one.…”

Section: Clinical Practicesupporting

confidence: 70%

Radiotherapy combined with immunotherapy: the dawn of cancer treatment

Zhang

Liu

Chen

et al. 2022

Sig Transduct Target Ther

183

141

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Radiotherapy (RT) is delivered for purposes of local control, but can also exert systemic effect on remote and non-irradiated tumor deposits, which is called abscopal effect. The view of RT as a simple local treatment has dramatically changed in recent years, and it is now widely accepted that RT can provoke a systemic immune response which gives a strong rationale for the combination of RT and immunotherapy (iRT). Nevertheless, several points remain to be addressed such as the interaction of RT and immune system, the identification of the best schedules for combination with immunotherapy (IO), the expansion of abscopal effect and the mechanism to amplify iRT. To answer these crucial questions, we roundly summarize underlying rationale showing the whole immune landscape in RT and clinical trials to attempt to identify the best schedules of iRT. In consideration of the rarity of abscopal effect, we propose that the occurrence of abscopal effect induced by radiation can be promoted to 100% in view of molecular and genetic level. Furthermore, the “radscopal effect” which refers to using low-dose radiation to reprogram the tumor microenvironment may amplify the occurrence of abscopal effect and overcome the resistance of iRT. Taken together, RT could be regarded as a trigger of systemic antitumor immune response, and with the help of IO can be used as a radical and systemic treatment and be added into current standard regimen of patients with metastatic cancer.

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Section: Clinical Practicesupporting

confidence: 70%

Radiotherapy combined with immunotherapy: the dawn of cancer treatment

Zhang

Liu

Chen

et al. 2022

Sig Transduct Target Ther

183

141

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“…In these stage IV patients, local response rates ranging from 74% to 89% and survival rates of 45 months have been observed [29] , [30] . Experiences that reported a significantly greater (but still acceptable, <14%) rate of brain radionecrosis for combination of immunotherapy (IT) and SRT with respect to SRT alone [31] are counter-balanced by as many which denied such a risk [32] , [33] , some of these with quite large population [33] . However, all of them agree that IT/SRT association improves survival outcomes.…”

Section: Introduction/rationalementioning

confidence: 99%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods: This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion: Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement

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“…However, radiotherapy was a tendency factor with a better overall survival. S. Scoccianti et al found that in non-adenocarcinoma histology, for patients receiving immunotherapy and stereotactic radiotherapy, the performance status of was a vital factor affecting prognosis (23). Another study pointed out that radiotherapy was a self-reliant factor of good prognosis in patients with NSCLC treated with immune checkpoint inhibitors (27).…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy improves the outcomes of immunotherapy with Sintilimab in non-small-cell lung cancer: A real-world analysis

Chen

Yang

et al. 2022

Front. Immunol.

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Introduction: Radiotherapy may augment systemic antitumor responses to immunotherapy. We did a retrospective study to infer whether radiotherapy improves outcomes to immunotherapy in patients with stage III and IV nonsmall-cell lung cancer (NSCLC).Methods: This retrospective study conducted at Enze Medical Center enrolled 259 patients with histopathology confirmed NSCLC from December 2018 to December 31, 2021. All were treated with Sintilimab, some patients received radiotherapy at an appropriate time point. Radiation type includes conventional radiotherapy and stereotactic body radiotherapy. The progression-free survival (PFS), and overall survival (OS) were the primary endpoint.Results: A retrospective analysis was performed on 259 patients, of whom 140 had been treated with immunotherapy lonely and 119 had been remedied with immunotherapy plus radiotherapy. Baseline variables were well balanced between the two groups, including gender, age, smoking status, TNM staging, number of metastases, ECOG score, pathological type and lines of previous systemic therapy. The median PFS in the immunotherapy alone group was 5.00 months (95%CI 4.38-5.62) versus immunotherapy plus radiotherapy was 9.00 months (5.95-12.05; p<0.001). The median OS in the immunotherapy alone group was 16.00 months (12.59-19.42) versus immunotherapy plus radiotherapy was 30.00 months (20.75-39.25; p=0.027). PFS was finer in the radiotherapy plus immunotherapy group than the immunotherapy group alone in both stage III (P=0.0069) and Stage IV(P=0.006) patients. In the univariate analysis, radiotherapy, male, ECOG=0 and <2 lines of previous systemic therapy were connected with an observably better PFS (P<0.001; P=0.03; P=0.002;P=0.021). In a multivariate analysis, radiotherapy, ECOG=0 and <2 lines of previous systemic therapy were independent prognostic factors with a markedly better Frontiers in Immunology frontiersin.org 01

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Immunotherapy in association with stereotactic radiotherapy for non-small cell lung cancer brain metastases: results from a multicentric retrospective study on behalf of AIRO

Cited by 32 publications

References 44 publications

Radiotherapy combined with immunotherapy: the dawn of cancer treatment

Radiotherapy combined with immunotherapy: the dawn of cancer treatment

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Radiotherapy improves the outcomes of immunotherapy with Sintilimab in non-small-cell lung cancer: A real-world analysis

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