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. 2019 Sep;6(5):402-409.
doi: 10.1093/nop/npz004. Epub 2019 Feb 5.

Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries

Claire M Lanier  1 , Ryan Hughes  1 , Tamjeed Ahmed  2 , Michael LeCompte  1 , Adrianna H Masters  1 , William J Petty  2 , Jimmy Ruiz  2   3 , Pierre Triozzi  2 , Jing Su  4 , Stacy O'Neill  5 , Kuonosuke Watabe  6 , Christina K Cramer  1 , Adrian W Laxton  7 , Stephen B Tatter  7 , Ge Wang  8 , Christopher Whitlow  4 , Michael D Chan  1
Affiliations

Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries

Claire M Lanier et al. Neurooncol Pract. 2019 Sep.

Abstract

Background: The effect of immunotherapy on brain metastasis patients remains incompletely understood. Our goal was to evaluate its effect on survival, neurologic death, and patterns of failure after stereotactic radiosurgery (SRS) without prior whole-brain radiation therapy (WBRT) in patients with lung and melanoma primaries metastatic to the brain.

Methods: We performed a retrospective analysis of 271 consecutive lung or melanoma patients treated with upfront SRS for brain metastases between 2013 and 2018. Of these patients, 101 (37%) received immunotherapy and 170 (63%) did not. Forty-three percent were treated with nivolumab. Thirty-seven percent were treated with pembrolizumab. Fifteen percent were treated with ipilimumab. One percent were treated with a combination of nivolumab and ipilimumab. One percent were treated with atezolizumab. Three percent were treated with another immunotherapy regimen. Survival was estimated by the Kaplan-Meier method and cumulative incidences of neurologic death, and local and distant brain failure were estimated using death as a competing risk.

Results: The median overall survival (OS) of patients treated with immunotherapy vs without was 15.9 (95% CI: 13.3 to 24.8) vs 6.1 (95% CI: 5.1 to 8.8) months (P < .01). The 1-year cumulative incidence of neurologic death was 9% in patients treated with immunotherapy vs 23% in those treated without (P = .01), while nonneurologic death was not significantly different (29% vs 41%, P = .51). Median brain metastasis velocity (BMV) did not differ between groups, and rates of salvage SRS and WBRT were similar.

Conclusions: The use of immunotherapy in patients with lung cancer or melanoma metastatic to the brain treated with SRS is associated with improved OS and decreased incidence of neurologic death.

Keywords: CTLA-4 inhibitor; PD-1/PD-L1 inhibitors; SRS; brain metastases; immunotherapy.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier plot of overall survival by immunotherapy.
Fig. 2
Fig. 2
Cumulative incidence of neurologic death for the overall cohort (left), neurologic death stratified by immunotherapy (middle) and nonneurologic death stratified by immunotherapy (right).
Fig. 3
Fig. 3
Cumulative incidence of distant brain failure (DBF) for the overall cohort (left), DBF stratified by immunotherapy (middle), and death without DBF (right).
See this image and copyright information in PMC

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