Retrospective analysis of safety and efficacy of anti-PD-1 therapy and radiation therapy in advanced melanoma: A bi-institutional study. (September 2019)

• Record Type: Journal Article
• Authors: Mowery, Yvonne M.; Patel, Kirtesh; Chowdhary, Mudit; Rushing, Christel N.; Roy Choudhury, Kingshuk; Lowe, Jared R.; Olson, Adam C.; Wisdom, Amy J.; Salama, Joseph K.; Hanks, Brent A.; Khan, Mohammad K.; Salama, April K.S.
• Is Part Of: Radiotherapy and oncology. Volume 138(2019)
• Page Start: 114
• Page End: 120
• Publication Date: 2019-09
• Subjects: PD-1 programmed cell death protein 1 -- RT radiation therapy -- OS overall survival -- AJCC American Joint Committee on Cancer -- CT computed tomography -- 18FDG-PET 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography -- AE adverse event -- CTCAE Common Terminology Criteria for Adverse Events -- PFS progression-free survival -- IQR interquartile range -- CI confidence interval -- SRS stereotactic radiosurgery -- HR hazard ratio -- WBRT whole brain radiation therapy -- ICB immune checkpoint blockade -- CTLA-4 cytotoxic T-lymphocyte associated protein-4 -- NSCLC non-small cell lung cancer; Melanoma -- Radiotherapy -- Programmed cell death 1 receptor -- Immunotherapy -- Dose fractionation -- Prognosis; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2019.06.013
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Worse baseline prognostic features for melanoma patients receiving RT vs no RT. Similar OS with no RT, RT during anti-PD-1, or RT after anti-PD-1 therapy. OS significantly worse with RT before anti-PD-1 therapy compared to no RT. RT in close temporal proximity to anti-PD-1 therapy is well tolerated. Abstract: Background and purpose: Antibodies against programmed cell death protein 1 (PD-1) are standard treatments for advanced melanoma. Palliative radiation therapy (RT) is commonly administered for this disease. Safety and optimal timing for this combination for melanoma has not been established. Materials and methods: In this retrospective cohort study, records for melanoma patients who received anti-PD-1 therapy at Duke University or Emory University (1/1/2013–12/30/2015) were reviewed. Patients were categorized by receipt of RT and RT timing relative to anti-PD-1. Results: 151 patients received anti-PD-1 therapy. Median follow-up was 12.9 months. Patients receiving RT ( n = 85) had worse baseline prognostic factors than patients without RT ( n = 66). One-year overall survival (OS) was lower for RT patients than patients without RT (66%, 95% CI: 55–77% vs 83%, 95% CI: 73–92%). One-year OS was 61% for patients receiving RT before anti-PD-1 (95% CI: 46−76%), 78% for RT during anti-PD-1 (95% CI: 60–95%), and 58% for RT after anti-PD-1 (95% CI: 26–89%). On Cox regression, OS for patients without RT did not differ significantly from patients receiving RT during anti-PD-1 (HR 1.07, 95% CI: 0.41–2.84) or RT before anti-PD-1 (HR 0.56, 95% CI: 0.21–1.45). RT and anti-PD-1 therapy administered within 6 weeks of each other was well tolerated. Conclusion: RT can be safely administered with anti-PD-1 therapy. Despite worse baseline prognostic characteristics for patients receiving RT, OS was similar for patients receiving concurrent RT with anti-PD-1 therapy compared to patients receiving anti-PD-1 therapy alone.