Meeting Coverage > > SNO– Meta-analysis reveals much better PFS, OS with RT-first technique, however concern needs more research study
by Charles Bankhead, Senior Editor, MedPage Today November 22, 2024
HOUSTON– Patients with cancer malignancy brain metastases had much better survival if they got radiotherapy (RT) followed by immunotherapy rather of the reverse series, a meta-analysis of 6 released research studies revealed.
Beginning treatment with an immune checkpoint inhibitor (ICI) was related to a 75-80% boost in the progression-free survival (PFS) danger ratio and about a 40% boost in the general survival (OS) risk ratio, the latter of which did not accomplish analytical significance. The findings did not alter whether the information were evaluated by random- or fixed-effects method, reported Philip Haddad, MD, of LSU Health Shreveport in Louisiana, at the Society for NeuroOncology conference.
“This is the very first and biggest meta-analysis to date to reveal that in clients with cancer malignancy brain metastases, the optimum series that affects clients' survival results is to begin with radiation treatment followed by immune checkpoint inhibitors,” Haddad stated in conclusion.
The findings need recognition in extra research study, especially potential research studies, he included.
Based upon formerly reported information, the research study is not brand-new, however a meta-analysis that takes a look at research studies in aggregate “in some cases can be handy,” stated Lia Moriguchi Halasz, MD, of Fred Hutch Cancer Center in Seattle.
[Sequencing] is an essential concern due to the fact that clients with brain metastases from cancer malignancy in some cases react to immunotherapy, and we are not constantly clear that including stereotactic radiosurgery is needed,” Moriguchi Halasz, who is a professional for the American Society for Radiation Oncology (ASTRO), informed MedPage Today“The meta-analysis findings are believed provoking, and recommend we require additional research study.”
“Overall survival for clients who got radiosurgery had just a pattern towards much better survival. Progression-free survival after radiosurgery is a challenging endpoint to translate considering that radiosurgery can likewise trigger swelling– radiation treatment impact– that is tough to identify from tumor development.”
No agreement presently exists about the ideal technique to integrating immunotherapy and RT for brain metastases.
“This is an essential, open concern regarding what is finest for these clients,” stated Moriguchi Halasz. “Generally, for symptomatic metastases, we think about earlier radiation treatment, offered the trials revealing action to immunotherapy were typically restricted to asymptomatic clients who did not need high-dose steroids. For asymptomatic clients, it is uncertain how these treatments must be sequenced.”
Whether the outcomes have applicability to brain metastases from other kinds of growths stays to be seen.
“I do believe brain metastases from cancer malignancy might be various from brain metastases from other kinds of cancer,” stated Moriguchi Halasz. “Melanoma is reasonably radioresistant compared to other kinds of cancer, and hence might react to a various series of treatments. Cancer malignancy is likewise among the most immunogenic cancers and might react in the brain in a different way to immunotherapy than other cancers.”
The reasoning for utilizing RT and ICIs together has actually originated from proof that RT “synergizes with ICIs to promote a more robust anti-tumor immune reaction,” stated Lisa Sudmeier,
