Abstract 3409
Background
Immune checkpoint inhibitors (ICPi) have dramatically changed the treatment of non-small cell lung cancer (NSCLC), but the effect of these agents on brain metastases (BM) has not been clearly elucidated. We retrospectively evaluated the effect of ICPi on BM.
Methods
NSCLC patients who harbored BM treated with ICPi in out institution were enrolled. History of radiation therapy (RT) to the brain was not included in the selection criteria. The primary endpoint was overall survival after the initiation of ICPi (OS), and the secondary endpoints were duration of ICPi administration, causes of withdrawal, responses of BM, time to the first response of BM, and the incidence of radiation necrosis (RN).
Results
35 NSLC with BM were treated with ICPi: nivolmab in 21, pembrolizumab in 13, and athezolizumab in 1 case. Among these cases, BM were progressive in 25 but stable in 10 cases at the initiation of ICPi. At the time of evaluation, ICPi were already withdrawn in 26 cases and the median administration time was 2.4 (0.5 to 25.9) months. The cause of withdrawal was progression of extracranial lesions in 8, progression of BM in 6, and adverse events or PS deterioration in the others. In competing risk analysis, the times to progression of extra- and intra-cranial lesions were not different. The responses of BM were evaluable in 28 cases: CR in 3, PR in 9, SD in 10 and PD in 6 cases. ICPi had been sequentially administrated after RT in one of the 3 CR and all of the 9 PR cases. The objective response rate was 76.9% after sequential RT/ICPi, but only 13.3% after ICPi alone (P = 0.002). The median time to the first response of BM was 1.0 (0.4 to 3.0) months after RT/ICPi and 1.3 (0.3 to 3.6) months after ICPi alone (n.s.). The median OS was 14.8 (95% CI: 8.8 to 22.7) months after the initiation of ICPi, and majority (90.5%) of the deaths were owing to the progression of extracranial disease. Among the 24 cases with history of RT to the brain, RN was observed in 7 (29.2%) and required necrotomy in 2 cases, even though ICPi could safely be continued after craniotomy in these 2 cases.
Conclusions
ICPi alone showed only limited efficacy on BM and were recommended to be administrated sequentially with RT. RN was the major neurological adverse event, and necrotomy was one of the choices to manage RN during ICPi.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
3158 - Tobacco Retail Access and Tobacco Cessation Among Head and Neck Cancer (HNC) Survivors
Presenter: Lawson Eng
Session: Poster Display session 1
Resources:
Abstract
5511 - ASSERT: A Prospective, Observational Study Measuring Sodium Improvement and Outcomes in Patients Treated for Moderate to Severe Hyponatremia Secondary to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in Italy (Lung Cancer Cohort)
Presenter: Rossana Berardi
Session: Poster Display session 1
Resources:
Abstract
3821 - Efficacy and safety of controlled ovarian stimulation with or without letrozole co-administration for fertility preservation: A systematic review and meta-analysis.
Presenter: Benedetta Bonardi
Session: Poster Display session 1
Resources:
Abstract
2168 - Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy
Presenter: Tineke Vandenbroucke
Session: Poster Display session 1
Resources:
Abstract
5855 - Update of the registry of young women with cancer by the International Network of Cancer, Infertility and Pregnancy
Presenter: Charlotte Maggen
Session: Poster Display session 1
Resources:
Abstract
5156 - Erectile dysfunction in patients with metastatic renal cell carcinoma
Presenter: Ilya Tsimafeyeu
Session: Poster Display session 1
Resources:
Abstract
4992 - Exercise level, interest and preferences in cancer patients.
Presenter: Alice Avancini
Session: Poster Display session 1
Resources:
Abstract
3427 - Filling the Gaps in Informed Consent for Advanced Cancer Patients considering Phase 1 Oncology Trials - an in-depth Qualitative Study of Key Stakeholders at a large United Kingdom Phase 1 unit
Presenter: Abhijit Pal
Session: Poster Display session 1
Resources:
Abstract
3537 - Breast Cancer Patients’ Quality of Life: Real World Data
Presenter: Thanos Kosmidis
Session: Poster Display session 1
Resources:
Abstract
4761 - High-sensitivity troponin as a cardiotoxicity biomarker in breast cancer treatment
Presenter: Joana Simões
Session: Poster Display session 1
Resources:
Abstract