The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

Cochran, Daniel C.; Chan, Michael D.; Aklilu, Mebea; Lovato, James; Alphonse, Natalie K.; Bourland, J. Daniel; Urbanic, James J.; McMullen, Kevin P.; Shaw, Edward G.; Tatter, Stephen B.; Ellis, Thomas L.

doi:10.3171/2012.2.jns111353

Cited by 82 publications

(83 citation statements)

References 22 publications

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“…115 A synergism between targeted therapies and SRS has been suggested. 116 Supportive care: This section can be found in the Supplementary material.…”

Section: Renal Cell Carcinomamentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

409

338

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The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of NeuroOncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care. Key wordsbrain metastases | chemotherapy | neuroimaging | neuropathology | stereotactic radiosurgery/stereotactic fractionated radiotherapy | supportive care | surgery | targeted therapy | whole-brain radiation therapy

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“…115 A synergism between targeted therapies and SRS has been suggested. 116 Supportive care: This section can be found in the Supplementary material.…”

Section: Renal Cell Carcinomamentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

409

338

View full text Add to dashboard Cite

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“…So far, little is known about the safety of the RT-TT association, especially in a concomitant setting. In a limited number of patients, rare studies have analyzed the toxicity of simultaneous RT-TT in metastatic RCC, and did not suggest increased infield RT toxicities [12,19].…”

Section: Discussionmentioning

confidence: 98%

Safety assessment of molecular targeted therapies in association with radiotherapy in metastatic renal cell carcinoma

et al. 2016

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Molecular targeted therapies (TT) are the cornerstone of metastatic renal cell carcinoma (RCC) treatment. There is a paucity of data on the safety of the radiotherapy (RT)-TT association in a sequential or a concomitant setting. The aim of the present study is to retrospectively assess the safety of the RT-TT association. From 2006 to 2014, data from 84 consecutive patients treated with RT and TT for metastatic RCC were retrospectively collected. RT-TT sequential and concomitant associations were, respectively, defined by a time interval of more than five TT half-lives and less than or equal to five TT half-lives between the last TT administration and RT initiation. Toxicities in the fields of RT were assessed systematically. As many patients received several TT and RT courses, 136 RT-TT associations were analyzed, with 66 sequential and 70 concomitant schemes. RT was mainly delivered on bone (75%) and brain metastases (14.7%). TT were tyrosine kinase inhibitors (73.5%), mTOR inhibitors (19.8%), and monoclonal antibodies (6.7%). With a median follow-up of 9.5 months, whatever the sequence, no grade≥4 toxicity was reported. Two grade 3 toxicities were reported with sequential (3%) and concomitant (2.9%) RT-TT, respectively. Sequential or concomitant RT-TT associations in metastatic RCC do not seem to cause major toxicity.

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“…One Wake Forest University series reported on 61 patients with RCC metastases treated with Gamma Knife SRS with or without sunitinib, sorafenib, or temsirolimus. The median survival duration for patients receiving targeted therapy increased from 7.2 to 16.6 months, with freedom from local failure increasing from 60% to 93% [33]. Safety and excellent local control has been shown in RCC patients given simultaneous antiangiogenic sorafenib or sunitinib therapy [32].…”

Section: Targeted Therapies For Breast Cancer Lung Cancer and Renalmentioning

confidence: 98%

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

et al. 2016

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Brain metastases are the most common intracranial malignancy. Many approaches, including radiation therapy, surgery, and cytotoxic chemotherapy, have been used to treat patients with brain metastases depending on the patient's disease burden and symptoms. However, stereotactic surgery (SRS) has revolutionized local treatment of brain metastases. Likewise, targeted therapies, including small-molecule inhibitors and monoclonal antibodies that target cancer cell metabolism or angiogenesis, have transformed managing systemic disease. Prospective data on combining these treatments for synergistic effect are limited, but early data show favorable safety and efficacy profiles.The combination of SRS and targeted therapy will further individualize treatment, potentially obviating the need for cytotoxic chemotherapy or whole-brain radiation.There is a great need to pursue research into these exciting modalities and novel combinations to further improve the treatment of patients with brain metastases.This article discusses reported and ongoing clinical trials assessing the safety and efficacy of targeted therapy during SRS. The Oncologist 2016;21:244-251 Implications for Practice: Treatment of patients with brain metastases requires a multidisciplinary approach. Stereotactic radiosurgery is increasingly used in the upfront setting to treat new brain metastasis. Targeted therapies have revolutionized systemic treatment of many malignancies and may sometimes be used as initial treatment in metastatic patients. There is sparse literature regarding safety and efficacy of combining these two treatment modalities. This article summarizes the supporting literature and highlights ongoing clinical trials in combining radiosurgery with targeted therapy.

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The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

Cited by 82 publications

References 22 publications

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Safety assessment of molecular targeted therapies in association with radiotherapy in metastatic renal cell carcinoma

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

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