Treatment of brain metastases with stereotactic radiosurgery and immune checkpoint inhibitors: An international meta-analysis of individual patient data

Eric J. Lehrer, Jennifer Peterson, Paul D. Brown, Jason P. Sheehan, Alfredo Quinones-Hinojosa, Nicholas G. Zaorsky, Daniel Trifiletti

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

Abstract

Background and purpose: While the combination of stereotactic radiosurgery (SRS) and immune checkpoint inhibitors (ICI) is becoming more widely used in the treatment of brain metastases (BM), there is a paucity of prospective data to validate both the safety and efficacy, as well as the optimal timing of these two therapies relative to one another. Methods: A PICOS/PRISMA/MOOSE selection protocol was used to identify 17 studies across 15 institutions in 3 countries. Inclusion criteria were patients: diagnosed with BMs; treated with SRS/ICI, either concurrently or non-concurrently; with at least one of the primary or secondary outcomes measures reported. Weighted random effects meta-analyses using the DerSimonian and Laird method was performed. The primary outcome was 1-year overall survival (OS). Secondary outcomes were 1-year local control (LC), 1-year regional brain control (RBC), and radionecrosis incidence. Results: A total of 534 patients with 1570 BM were included. The 1-year OS was 64.6% and 51.6% for concurrent and non-concurrent therapy, respectively (p < 0.001). Local control at 1-year was 89.2% and 67.8% for concurrent and non-concurrent therapy, respectively (p = 0.09). The RBC at 1-year was 38.1% and 12.3% for concurrent and ICI administration prior to SRS, respectively (p = 0.049). The overall incidence of radionecrosis for all studies was 5.3%. Conclusions: Concurrent administration of SRS/ICI may be associated with improved safety and efficacy versus sequential therapy. These findings, however, are hypothesis-generating and require further validation by ongoing and planned prospective trials.

Original languageEnglish (US)
JournalRadiotherapy and Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Immunotherapy
  • Ipilimumab
  • Nivolumab
  • Pembrolizumab
  • Radiation
  • Steroid

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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