Initial Experience after Transition to Immune Checkpoint Inhibitors in Patients with Non-small Cell Lung Cancer Treated in a Rural Healthcare Region

Nieder, Carsten; Reigstad, Anne; Carlsen, Espen A; Flatøy, Liv Randi; Tollåli, Terje

doi:10.7759/cureus.7030

Cited by 7 publications

(8 citation statements)

References 16 publications

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“…A retrospective single-institution quality-of-care analysis was performed, based on electronic health records and a previously utilized brain metastases database, which does not include patients with leptomeningeal spread (Nieder et al 2019b(Nieder et al , 2020. Magnetic resonance imaging was used to diagnose the brain metastases, without histological confirmation.…”

Section: Methodsmentioning

confidence: 99%

“…Also at the authors’ institution, which has an extremely low rate of patients with EGFR mutations or other targetable alterations influencing first-line treatment (Nieder et al 2020 ), early radiotherapy was the prevailing strategy for patients with brain metastases from lung cancer undergoing active treatment rather than supportive, palliative measures. Nevertheless, on a case-by-case basis, the MDT sometimes recommended primary cytotoxic chemotherapy and recently immune checkpoint inhibitors (ICI) or ICI plus chemotherapy if no actionable target was present.…”

Section: Introductionmentioning

confidence: 99%

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Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents

Nieder

Aanes

Haukland

2022

J Cancer Res Clin Oncol

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Purpose The purpose of this study was to evaluate overall survival after systemic therapy, largely chemotherapy, in patients with small cell or non-small cell lung cancer and brain metastases. After completion of systemic therapy, some patients received planned brain irradiation, while others were followed. Methods Retrospective cohort study. Results Thirty-eight patients were included (28 small cell, 20 followed with imaging). Six of these 20 patients (30%) received delayed radiotherapy during follow-up. Planned radiotherapy (n = 18, intention-to-treat) was associated with longer survival from diagnosis of brain metastases, median 10.8 versus 6.1 months, p = 0.025. Delayed radiotherapy still resulted in numerically better survival than no radiotherapy at all (median 8.8 versus 5.3 months, not significant). If calculated from the start of delayed radiotherapy, median survival was only 2.7 months. In a multivariable analysis, both Karnofsky performance status ≥ 70 (p = 0.03) and planned radiotherapy (p = 0.05) were associated with better survival. Conclusion In patients ineligible for targeted agents, planned radiotherapy in a modern treatment setting was associated with longer survival compared to no radiotherapy. Timing and type of radiotherapy in such patients should be evaluated in prospective trials to identify patients who might not need planned radiotherapy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents

Nieder

Aanes

Haukland

2022

J Cancer Res Clin Oncol

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“…Their multidisciplinary treatment involves different radiotherapy modalities, surgical resection, and systemic therapy [2][3][4][5][6][7][8]. Defined subtypes of NSCLC, e.g., those with epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) translocations, may respond to targeted agents; however, wild-type NSCLC (negative EGFR, ALK, and other common alterations) is the prevailing tumor type in the authors' geographical region [9]. Thus, chemotherapy and immune checkpoint inhibitors (ICIs) are the mainstay of systemic therapy.…”

Section: Introductionmentioning

confidence: 99%

A Case of Five-Year Survival After Combined-Modality Treatment for Non-Small Cell Lung Cancer With Intraspinal Metastasis

Nieder¹,

Mannsåker²

2022

Cureus

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This case report describes the treatment approach and outcome in a 69-year-old female patient with nonsmall cell lung cancer (NSCLC) diagnosed with T4 N2 M1b (intraspinal) disease. The two most common targets for tyrosine kinase inhibitors (epidermal growth factor receptor and anaplastic lymphoma kinase) were not expressed. Programmed death-ligand 1 (PD-L1) was expressed in <50% of the tumor cells. In 2016, initial guideline-concordant treatment with carboplatin/vinorelbine chemotherapy was initiated. Between the first two cycles, all positron emission tomography (PET) positive lesions were irradiated with 30 Gy in 10 fractions (lung, nodes, thoracic spinal manifestation). After nine months with excellent response (at least partial remission, possibly fibrosis only), bilateral lung metastases were diagnosed. The patient was started on nivolumab monotherapy (later atezolizumab due to a change in National practice) and completed two years of treatment. She is currently in continued complete remission with regular follow-up examinations. This case illustrates that outcomes comparable to those observed in patients with limited brain metastases may be observed in patients with localized intraspinal disease and that immune checkpoint inhibitors play an important role in the management of metastatic NSCLC.

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“…Nevertheless, unplanned termination of short multi-fraction regimens might still occur, mainly as a consequence of the rapid deterioration of patient's performance status (PS) [2,3]. Lack of support and/or financial resources is a less common cause of incomplete radiotherapy and is virtually absent in Norway where the publicly funded healthcare system provides transportation, housing, access to community-based oncology nurses, home care and other services [4,5]. Thus, barriers that were identified in other healthcare regions, e.g.…”

Section: Introductionmentioning

confidence: 99%

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

Nieder¹,

Mannsåker²,

Yobuta³

2022

Cureus

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Introduction:The recently published METSSS model, which was developed for prediction of survival after palliative radiotherapy, includes age, sex, cancer type, localization of distant metastases, Charlson-Deyo comorbidity score and radiotherapy site. Its ability to predict other relevant endpoints has not been studied yet. Therefore, this exploratory study analyzed the endpoints "unplanned termination of radiotherapy" and "treatment in the last 30 days of life" in the METSSS-defined risk groups (low/medium/high).Methods: The risk group was assigned in the METSSS online calculator for our patient cohort with nonhematological malignancies treated between 2009 and 2014 during the first course of treatment (resembling details of the original METSSS study). All patients were treated with classical palliative dose/fractionation regimes such as five fractions of 4 Gy, 10 fractions of 3 Gy or 13 fractions of 3 Gy. No stereotactic high-dose radiation was utilized. Given that single-fraction radiotherapy cannot be discontinued, patients treated with 8 Gy x1 for uncomplicated painful bone metastases were excluded. Both completed and discontinued multifraction radiotherapy courses (at least two fractions intended) were included.Results: The study included 290 patients, 19 of whom failed to complete their prescribed course of palliative radiotherapy (7%). Thirty-nine (13%) were irradiated in the last 30 days of life. Only one patient was classified as low-risk according to the METSSS model (medium: 15, high: 274). Only Eastern Cooperative Oncology Group (ECOG) performance status (PS) was significantly associated with incomplete treatment. All 16 patients with low/medium METSSS risk scores completed their prescribed course of radiotherapy, compared to the 93% completion rate in the high-risk group, p=0.41. With regard to treatment in the last 30 days of life, ECOG PS, metastases to brain, liver and lung, and the number of prescribed fractions were statistically significant. One patient with a low/medium METSSS risk score was treated in the last 30 days of life (6%), compared to 14% in the high-risk group, p=0.49. Conclusion:Unexpected imbalances in the METSSS risk group size resulted in lower statistical power than anticipated. Patients with low/medium METSSS risk scores performed numerically better. However, other predictive factors, especially ECOG PS, which is not part of the METSSS model, maybe more relevant. Further efforts towards the application of the model beyond its original objective cannot be recommended.

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Initial Experience after Transition to Immune Checkpoint Inhibitors in Patients with Non-small Cell Lung Cancer Treated in a Rural Healthcare Region

Cited by 7 publications

References 16 publications

Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents

Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents

A Case of Five-Year Survival After Combined-Modality Treatment for Non-Small Cell Lung Cancer With Intraspinal Metastasis

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

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