Concurrent Immunotherapy With Stereotactic Radiation for Brain Metastases is Not Associated With Increased Rates of Radionecrosis

Int J Radiat Oncol Biol Phys. 2021 Nov 1;111(3S):e562-e563. doi: 10.1016/j.ijrobp.2021.07.1522.ABSTRACTPURPOSE/OBJECTIVE(S): Early concerns were raised about higher rates of radionecrosis (RN) with concurrent use of immune checkpoint inhibition (ICI) and stereotactic radiotherapy (SRT) for brain metastases (BM). We sought to clarify if this same concern translated to linear accelerator-based SRT for BM.MATERIALS/METHODS: We retrospectively reviewed cases of SRT delivered at a single institution for BM (2004-2019). In total, 251 patients and 723 courses of treatment were analyzed on a per-treatment basis for any grade RN. RN was graded by CTCAE v5 and defined as an enlarging lesion after SRT that resolved spontaneously, resolved with steroids, or was surgically resected and found to have no viable tumor. Differences were assessed with Chi-squared, Kaplan-Meier, and univariable/multivariable Cox regression analyses with candidate variables including timing of ICI with SRT (neoadjuvant, concurrent defined as within 3 months, or adjuvant), primary histology, and symptomatic vs not at time of BM diagnosis, among others.RESULTS: In total, 251 patients received SRT for BM: 53 without ICI, 58 neoadjuvant ICI, 102 concurrent ICI, and 38 adjuvant ICI. Median follow up for the surviving patients who received any ICI was 24.0 months (IQR 7.6-41.4) and not different from those without ICI at 26.8 months (IQR 8.8-45.6) (P = 0.22) with 38% of patients alive at last follow up. Analyzed by ti...
Source: Ann Oncol - Category: Cancer & Oncology Authors: Source Type: research

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ConclusionsOur study suggests improved survival with gross total resection compared to subtotal resection. The importance of extent of resection in surgery  for brain metastases should not be discarded.
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research
il R. Lakhani HER2+ breast cancer patients have an elevated risk of developing brain metastases (BM), despite adjuvant HER2-targeted therapy. The mechanisms underpinning this reduced intracranial efficacy are unclear. We optimised the in situ proximity ligation assay (PLA) for detection of the high-affinity neuregulin-1 receptor, HER2-HER3 (a key target of pertuzumab), in archival tissue samples and developed a pipeline for high throughput extraction of PLA data from fluorescent microscope image files. Applying this to a large BM sample cohort (n = 159) showed that BM from breast, ovarian, lung and kidney cancers have ...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Conclusion: Patients receiving an ACT and single-fraction SRS for small- to medium-sized BM did not seem to have a clinically relevant risk of ICH. Previous bleeding and metastases originating from a malignant melanoma may favor bleeding events after SRS. Further studies are needed to validate our reported findings.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
AbstractPediatric glioblastoma is relatively rare compared with its adult counterpart but is associated with a similarly grim prognosis. Available data indicate that pediatric glioblastomas are molecularly distinct from adult tumors, and relatively little is known about the pediatric glioblastoma tumor microenvironment (TME). Cancer immunotherapy has emerged as a new pillar of cancer treatment and is revolutionizing the care of patients with many advanced solid tumors, including melanoma, non-small cell lung cancer, head and neck cancer, and renal cell carcinoma. Unfortunately, attempts to treat adult glioblastoma with cur...
Source: Cancer Immunology, Immunotherapy - Category: Cancer & Oncology Source Type: research
ConclusionCerebral pseudoprogression followed three distinct patterns and was detectable in 3.2% of all patients during ICI treatment and in 9.75% of the patients with sufficient brain imaging follow up. The fact that all but one of the affected patients developed neurological symptoms, which would be classified as progressive disease according to iRANO criteria, mandates vigilance in the diagnosis and treatment of ICI-induced cerebral lesions.
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Adv Exp Med Biol. 2021;1342:233-258. doi: 10.1007/978-3-030-79308-1_7.ABSTRACTImmunotherapy has changed the landscape of treatment of many solid and hematological malignancies and is at the forefront of cancer breakthroughs. Several circumstances unique to the central nervous system (CNS) such as limited space for an inflammatory response, difficulties with repeated sampling, corticosteroid use for management of cerebral edema, and immunosuppressive mechanisms within the tumor and brain parenchyma have posed challenges in clinical development of immunotherapy for intracranial tumors. Nonetheless, the success of immunothera...
Source: Cancer Control - Category: Cancer & Oncology Authors: Source Type: research
Adv Exp Med Biol. 2021;1342:81-111. doi: 10.1007/978-3-030-79308-1_3.ABSTRACTMelanoma is the leading cause of death from skin cancer and is responsible for over 7000 deaths in the USA each year alone. For many decades, limited treatment options were available for patients with metastatic melanoma; however, over the last decade, a new era in treatment dawned for oncologists and their patients. Targeted therapy with BRAF and MEK inhibitors represents an important cornerstone in the treatment of metastatic melanoma; however, this chapter carefully reviews the past and current therapy options available, with a significant focu...
Source: Advances in Experimental Medicine and Biology - Category: Research Authors: Source Type: research
Adv Exp Med Biol. 2021;1342:233-258. doi: 10.1007/978-3-030-79308-1_7.ABSTRACTImmunotherapy has changed the landscape of treatment of many solid and hematological malignancies and is at the forefront of cancer breakthroughs. Several circumstances unique to the central nervous system (CNS) such as limited space for an inflammatory response, difficulties with repeated sampling, corticosteroid use for management of cerebral edema, and immunosuppressive mechanisms within the tumor and brain parenchyma have posed challenges in clinical development of immunotherapy for intracranial tumors. Nonetheless, the success of immunothera...
Source: Advances in Experimental Medicine and Biology - Category: Research Authors: Source Type: research
Adv Exp Med Biol. 2021;1342:81-111. doi: 10.1007/978-3-030-79308-1_3.ABSTRACTMelanoma is the leading cause of death from skin cancer and is responsible for over 7000 deaths in the USA each year alone. For many decades, limited treatment options were available for patients with metastatic melanoma; however, over the last decade, a new era in treatment dawned for oncologists and their patients. Targeted therapy with BRAF and MEK inhibitors represents an important cornerstone in the treatment of metastatic melanoma; however, this chapter carefully reviews the past and current therapy options available, with a significant focu...
Source: Advances in Experimental Medicine and Biology - Category: Research Authors: Source Type: research
Conclusions: Military fighter aviation may be associated with slightly increased risk of certain cancers.
Source: Journal of Occupational and Environmental Medicine - Category: Occupational Health Tags: ORIGINAL ARTICLES Source Type: research
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