Toxicity and efficacy of Gamma Knife radiosurgery for brain metastases in melanoma patients treated with immunotherapy or targeted therapy-A retrospective cohort study.
Adult
Aged
Aged, 80 and over
Austria
/ epidemiology
Brain Neoplasms
/ immunology
CTLA-4 Antigen
/ antagonists & inhibitors
Combined Modality Therapy
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Female
Follow-Up Studies
Humans
Immune Checkpoint Inhibitors
/ adverse effects
Immunotherapy
/ adverse effects
Male
Melanoma
/ immunology
Middle Aged
Molecular Targeted Therapy
Prognosis
Programmed Cell Death 1 Receptor
/ antagonists & inhibitors
Radiation Tolerance
Radiosurgery
/ adverse effects
Retrospective Studies
Survival Rate
brain metastases
gamma knife radiosurgery
immunotherapy
melanoma
targeted therapy
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
19
11
2019
revised:
28
02
2020
accepted:
02
03
2020
pubmed:
7
4
2020
medline:
14
5
2021
entrez:
7
4
2020
Statut:
ppublish
Résumé
Few safety data of concurrent stereotactic radiosurgery and targeted therapy (TT) or immunotherapy (IT) are available. The aim of the study was to evaluate the outcome of melanoma patients with brain metastases (MBM) after Gamma Knife Radiosurgery (GKRS) in relation to IT/TT. We evaluated 182 MBM patients, who were treated with GKRS in the modern radiosurgical and oncological era. The median time between the initial melanoma diagnosis and occurrence of MBM was 2.4 years. The median overall survival time was 5.4 years after melanoma diagnosis. The estimated median survival after the initial diagnosis of MBM was 1.0 year (95% CI = 0.7-1.2 years). Patients treated with anti-PD-1 or a combination of anti-CTLA-4/PD-1 showed a significantly longer survival after first GKRS compared to all other forms of treatment. In addition, patients treated with anti-PD-1, anti-CTLA-4, or a combination of anti-CTLA-4/PD-1 showed a significantly longer time to new MBM after GKRS1 compared to patients treated with other forms and combinations of the oncological therapy. The occurrence of hemorrhage or radiation reaction/necrosis after GKRS did not show any statistically significant differences in relation to IT/TT. In MBM patients, complications after GKRS are not significantly increased if IT/TT treatment is performed at the time of or after radiosurgery. Further, a clear benefit in distant control and survival is seen in MBM patients treated with GKRS and checkpoint inhibitors. Thus, concomitant treatment of MBM with GKRS and IT/TT seems to be a safe and powerful treatment option although further prospective studies should be conducted.
Sections du résumé
BACKGROUND
Few safety data of concurrent stereotactic radiosurgery and targeted therapy (TT) or immunotherapy (IT) are available. The aim of the study was to evaluate the outcome of melanoma patients with brain metastases (MBM) after Gamma Knife Radiosurgery (GKRS) in relation to IT/TT.
METHODS
We evaluated 182 MBM patients, who were treated with GKRS in the modern radiosurgical and oncological era.
RESULTS
The median time between the initial melanoma diagnosis and occurrence of MBM was 2.4 years. The median overall survival time was 5.4 years after melanoma diagnosis. The estimated median survival after the initial diagnosis of MBM was 1.0 year (95% CI = 0.7-1.2 years). Patients treated with anti-PD-1 or a combination of anti-CTLA-4/PD-1 showed a significantly longer survival after first GKRS compared to all other forms of treatment. In addition, patients treated with anti-PD-1, anti-CTLA-4, or a combination of anti-CTLA-4/PD-1 showed a significantly longer time to new MBM after GKRS1 compared to patients treated with other forms and combinations of the oncological therapy. The occurrence of hemorrhage or radiation reaction/necrosis after GKRS did not show any statistically significant differences in relation to IT/TT.
CONCLUSION
In MBM patients, complications after GKRS are not significantly increased if IT/TT treatment is performed at the time of or after radiosurgery. Further, a clear benefit in distant control and survival is seen in MBM patients treated with GKRS and checkpoint inhibitors. Thus, concomitant treatment of MBM with GKRS and IT/TT seems to be a safe and powerful treatment option although further prospective studies should be conducted.
Identifiants
pubmed: 32249551
doi: 10.1002/cam4.3021
pmc: PMC7286469
doi:
Substances chimiques
CTLA-4 Antigen
0
CTLA4 protein, human
0
Immune Checkpoint Inhibitors
0
PDCD1 protein, human
0
Programmed Cell Death 1 Receptor
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4026-4036Informations de copyright
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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