Abstract
BackgroundRadiation therapy (RT) is the mainstay of brain metastases (BMs), and anti-PD-1 blockade has led to intracranial responses in non-small cell lung carcinoma (NSCLC) patients with BMs.ObjectiveThis study aimed to evaluate the efficacy and safety of adding anti-PD-1 blockade to RT in the management of NSCLC patients with BM in terms of survival outcome.Materials and MethodsWe retrospectively reviewed 70 NSCLC patients with BMs who were treated with whole brain radiation therapy (WBRT) between January 2016 and January 2021. Of the 70 patients, 29 additionally received anti-PD-1 therapy within 30 days of WBRT initiation. Baseline characteristics of the patients and efficacy outcomes such as progression-free survival (PFS) and overall survival (OS) were statistically compared using SPSS v26. Results were obtained using the Chi-square test/Fisher exact test, t-test, Kaplan-Meier, and Cox regression survival analyses.ResultsThe median survival for the entire cohort was 24 months (95% CI, 19.5–28.5). The median survival times for WBRT alone and WBRT plus anti-PD-1 therapy cohorts were 20 months (95% CI, 11.6–28.3) and 27 months (95% CI, 19.5–28.5), respectively (p=0.035). There was no statistical difference in PFS for the treatment cohorts (median PFS for WBRT alone: 7 months vs. 12 months for WBRT plus anti-PD-1, p=0.247). In EGFR wild-type subgroup (n=31), both PFS (p=0.037) and OS (p=0.012) were significantly improved. Only the treatment group (WBRT plus anti-PD-1) was a significant predictor of OS on univariate and multivariate analyses (p=0.040). There were no significant differences in adverse events among the treatment groups.ConclusionsNSCLC patients with BM receiving additional anti-PD-1 therapy may derive better OS than WBRT alone without any increase in adverse events. Prospective well-designed studies are warranted to validate and elucidate the additive effects of the two modalities in this group of patients.
Highlights
Lung cancer is the second most common cancer type in terms of incidence rate (T: 228820, 12.7%; M: 116, 300 13%; F: 112, 520 12%), and is the leading cause of death (T: 135720, 22%; M: 72,500 23%; F: % 63220 22%) in both sexes according to newly estimated new cancer cases and deaths by sex in the United States in 2020 [1]
All patients were treated with whole brain radiation therapy (WBRT) between 2016 and 2021
The majority of the patients in the WBRT alone group were EGFR+ (25 vs. 5), and the difference was significant between the treatment groups according to EGFR status (p=0.004)
Summary
Lung cancer is the second most common cancer type in terms of incidence rate (T: 228820, 12.7%; M: 116, 300 13%; F: 112, 520 12%), and is the leading cause of death (T: 135720, 22%; M: 72,500 23%; F: % 63220 22%) in both sexes according to newly estimated new cancer cases and deaths by sex in the United States in 2020 [1]. Non-small cell lung carcinoma (NSCLC) accounts for 85% of lung cancer cases and is the most frequent primary site for brain metastasis (BM) [1,2,3]. BM patients with a high intracranial burden are primarily offered whole brain radiation therapy (WBRT). Stereotactic radiosurgery (SRS) has been restricted to patients with up to 3 BMs. recent trends indicate that SRS/ stereotactic radiotherapy (SRT) has been increasingly offered to patients with >3 BMs with WBRT used as salvage therapy [5, 9, 10, 12]. Radiation therapy (RT) is the mainstay of brain metastases (BMs), and anti-PD-1 blockade has led to intracranial responses in non-small cell lung carcinoma (NSCLC) patients with BMs
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