Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries

Lanier, C.M.; Hughes, Ryan T.; Ahmed, Tamjeed; LeCompte, M.C.; Masters, Adrianna Henson; Petty, W. Jeffrey; Ruiz, Jimmy; Triozzi, Pierre L.; Su, Jing; O'Neill, S.S.; Watabe, Kuonosuke; Cramer, Christina K.; Laxton, Adrian W.; Tatter, Stephen B.; Wang, Ge; Whitlow, Christopher T.; Chan, Michael D.

doi:10.1093/nop/npz004

Cited by 54 publications

(43 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, Diao et al reviewed 91 melanoma patients treated with SRS for brain metastases and showed that patients who received ipilimumab had better OS than patients who did not received ipilimumab (median OS 15.1 months vs 7.8 months, p = 0.02) 97 . Besides, similar results have been reported in some other retrospective studies 98 - 100 . Therefore, ICI-SABR is a promising strategy for metastatic melanoma and several phase I/II clinical trials are underway to further confirm the safety and efficacy of this combination (NCT03354962, NCT02858869, and NCT02716948).…”

Section: Synergistic Effect Of Sabr and Immune Checkpoint Inhibitosupporting

confidence: 91%

Radiobiology of stereotactic ablative radiotherapy (SABR): perspectives of clinical oncologists

Li¹,

Shen²

2020

J. Cancer

View full text Add to dashboard Cite

Stereotactic ablative radiotherapy (SABR) is a novel radiation treatment method that delivers an intense dose of radiation to the treatment targets with high accuracy. The excellent local control and tolerance profile of SABR have made it become an important modality in cancer treatment. The radiobiology of SABR is a key factor in understanding and further optimizing the benefits of SABR. In this review, we have addressed several issues in the radiobiology of SABR from the perspective of clinical oncologists. The appropriateness of the linear-quadratic (LQ) model for SABR is controversial based on preclinical data, but it is a reliable tool from the perspective of clinical application because the biological effective dose (BED) calculated with it can represent the tumor control probability (TCP). Hypoxia is a common phenomenon in SABR in spite of the relatively small tumor size and has a negative effect on the efficacy of SABR. Preliminary studies indicate that a hypoxic radiosensitizer combined with SABR may be a feasible strategy, but so far there is not adequate evidence to support its application in routine practice. The vascular change of endothelial apoptosis and blood perfusion reduction in SABR may enhance the response of tumor cells to radiation. Combination of SABR with anti-angiogenesis therapy has shown promising efficacy and good tolerance in advanced cancers. SABR is more powerful in enhancing antitumor immunity and works better with immune checkpoint inhibitors (ICIs) than conventional fractionation radiotherapy. Combination of SABR with ICIs has become a practical option for cancer patients with metastases.

show abstract

Section: Synergistic Effect Of Sabr and Immune Checkpoint Inhibitosupporting

confidence: 91%

Radiobiology of stereotactic ablative radiotherapy (SABR): perspectives of clinical oncologists

Li¹,

Shen²

2020

J. Cancer

View full text Add to dashboard Cite

show abstract

“…2 With the advances in immunology, immunotherapy has shown excellent outcomes in various diseases, especially melanoma. 3 However, patient responses to nivolumab therapy have been reported to range from 10% to 20%. 4 In most melanoma patients, clinical survival is reduced due to the metastases of advanced tumors.…”

Section: Introductionmentioning

confidence: 99%

“…The most effective therapy to treat melanoma is surgical resection 2 . With the advances in immunology, immunotherapy has shown excellent outcomes in various diseases, especially melanoma 3 . However, patient responses to nivolumab therapy have been reported to range from 10% to 20% 4 .…”

Section: Introductionmentioning

confidence: 99%

Correlation of tumor‐infiltrating immune cells of melanoma with overall survival by immunogenomic analysis

Huang

Chen

et al. 2020

Cancer Medicine

View full text Add to dashboard Cite

AimsDifferent types of tumor‐infiltrating immune cells not only augment but also dampen antitumor immunity in the microenvironment of melanoma. Therefore, it is critical to provide an overview of tumor‐infiltrating immune cells in melanoma and explore a novel strategy for immunotherapies.MethodsWe analyzed the immune states of different stages in melanoma patients by the immune, stromal, and estimation of stromal and immune cells in malignant tumor tissues using expression data (ESTIMATE) scores. Immune cell types were identified by the estimating relative subsets of RNA transcripts (CIBERSORTx) algorithm in 471 melanoma and 324 healthy tissues. Moreover, we performed a gene set variation analysis (GSVA) to determine the differentially regulated pathways in the tumor microenvironment.ResultsIn melanoma cohorts, we found that ESTIMATE and immune scores were involved in survival or tumor clinical stage. Among the 22 immune cells, CD8+ T cells, M2 macrophages, and regulatory T cells (Tregs) showed significant differences using the CIBERSORTx algorithm. Furthermore, GSVA identified the immune cell‐related pathways; the primary immunodeficiency pathway, intestinal immune network for IgA, and TGF‐β pathways were identified as participants of the crosstalk in CD8+ T cells, Tregs, and M2 macrophages in the melanoma microenvironment.ConclusionThese results reveal the cellular and molecular characteristics of immune cells in melanoma, providing a method for selecting targets of immunotherapies and promoting the efficacy of therapies for the treatment of melanoma.

show abstract

“…Patients with metastatic NSCLC showed a similar pattern: Magnuson et al presented in a retrospective multiinstitutional analysis that patients who received upfront SRS followed by epidermal growth factor receptor (EGFR) TKI had superior outcome concerning OS compared to the patients who received EGFR-TKI primarily, with SRS as a salvage option [36]. Another study by Lanier et al suggests that immunotherapy after SRS improves OS and reduces the rate of neurological deaths of patients with melanoma or NSCLC [37]. In addition to the bene ts in treatment outcome, SRS also offers practical advantages for oncological treatments in general: by limiting the duration of the treatment to one day (compared to two weeks for WBRT with 30 Gy in 10 fractions), the systemic treatment does not have to be paused or postponed for too long, so that treatment can be started or continued in cases of acute systemic progression.…”

Section: Discussionmentioning

confidence: 93%

Simultaneous stereotactic radiosurgery of multiple brain metastases using single isocenter dynamic conformal arc therapy: a prospective monocentric registry trial

Bodensohn

Kaempfel

Fleischmann

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Single-isocenter dynamic conformal arc (SIDCA) therapy is an efficient way of delivering stereotactic radiosurgery (SRS) to multiple metastases simultaneously. This study reports on the safety and feasibility of SRS with SIDCA for patients with multiple brain metastases.Methods All patients who received SRS with this technique between November 2017 and June 2019 within a prospective registry trial, were included. The patients were irradiated using a VersaHD® linear accelerator (LINAC) from Elekta (Stockholm, Sweden). Follow-up was performed every three months, including a clinical and radiological examination with cranial magnetic resonance imaging (MRI). The data were analyzed using descriptive statistics and the Kaplan-Meier method.Results 65 patients with 254 lesions (range 2–12) were included in this analysis. Median beam on time was 23 minutes. The median follow-up at the time of analysis was 13 months (95% CI 11.1–14.9). Median overall survival and median progression-free survival was 15 months (95% CI 7.7–22.3) and 18 months (95% CI 11.1–24.9), respectively. Intracranial and local control after 6 months was 73.0% and 97.5%, respectively. During follow-up, CTCAE grade 1 adverse effects (AE) were experienced by 29 (44.6%) patients (18 of them therapy-related (27.7%)), CTCAE grade 2 AEs by 4 (6.2%) patients (one of them therapy-related (1.5%)) and CTCAE grade 3 by 3 patients (4.6%) (none of them therapy-related). 2 lesions (0.8%) in 2 patients (3.1%) were proven as radiation necrosis. Conclusions Simultaneous SRS using SIDCA seems to be a feasible and safe treatment for patients with multiple metastases.

show abstract

Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries

Cited by 54 publications

References 32 publications

Radiobiology of stereotactic ablative radiotherapy (SABR): perspectives of clinical oncologists

Radiobiology of stereotactic ablative radiotherapy (SABR): perspectives of clinical oncologists

Correlation of tumor‐infiltrating immune cells of melanoma with overall survival by immunogenomic analysis

Simultaneous stereotactic radiosurgery of multiple brain metastases using single isocenter dynamic conformal arc therapy: a prospective monocentric registry trial

Contact Info

Product

Resources

About