Stereotactic radiosurgery combined with anti-PD1 for the management of melanoma brain metastases: A retrospective study of safety and efficacy. (August 2020)

• Record Type: Journal Article
• Authors: Carron, Romain; Gaudy-Marqueste, Caroline; Amatore, Florent; Padovani, Laetitia; Malissen, Nausicaa; Balossier, Anne; Loundou, Anderson; Bonnet, Nathalie; Muracciole, Xavier; Régis, Jean-Marie; Grob, Jean-Jacques
• Is Part Of: European journal of cancer. Volume 135(2020)
• Page Start: 52
• Page End: 61
• Publication Date: 2020-08
• Subjects: Anti-PD1 -- Brain metastases -- Melanoma -- Stereotactic radiosurgery; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2020.04.028
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Brain metastases can be effectively treated with stereotactic radiosurgery (SRS). Immune checkpoint inhibitors are now pivotal in metastatic melanoma care, but some concerns have emerged regarding the safety of their combination with radiation therapy. Methods: We present a retrospective analysis of a cohort of patients treated by anti-PD1 and SRS as a sole modality of radiation therapy (no whole brain radiation therapy at any time) in a single institution. We included patients on anti-PD1 at the time of SRS or patients who started anti-PD1 within a maximum period of 3 months following SRS and were treated at least one year before the analysis. Clinical and serial imaging data were reviewed to determine the efficacy and the rate of adverse radiation effectss of the combination. Results: A total of 50 patients were included. SRS targeted 1, 2 to 3 and >3 brain metastases in 17, 16 and 17 patients, respectively. Two patients died before the first evaluation. Nine patients presented with an increase in peritumoral oedema, three with intracranial haemorrhage and one patient with both oedema and haemorrhage. Median follow-up was 38.89 months (interquartile range 24.43; 45.28). Median overall survival from SRS was 16.62 months with 1-, 2- and 3-year rates of 60%, 40% and 35%, respectively. Median brain-Progression Free Survival was 13.2 months with 1, 2 and 3-year rates of 62.1%, 49.7% and 49.7%, respectively. Conclusions: This real-world cohort of patients treated with a homogeneous strategy combining upfront stereotactic radiosurgery and anti-PD1 shows remarkable survival rates and does not reveal unexpected toxicity. Highlights: Real-word cohort of patients with a standardised strategy of treatment. Stereotactic radiosurgery and anti-PD1 can be safely combined This combination is effective for the treatment of melanoma brain metastases. Outcomes are favourable with a 2-years brain-PFS rate of 50%. Data do not suggest an increased risk of adverse radiation effects.