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Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases

PURPOSE: To investigate the impact of radiotherapy (RT) and immune checkpoint inhibitor (ICI) sequence on the survival outcome in NSCLC patients with brain metastasis, and decide the best time to initiate RT. METHODS: Patients were managed with delayed RT (ICI delivered over 2 weeks prior to RT), co...

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Autores principales: Yu, Yaner, Chen, Haiyan, Tian, Zhifeng, Zhang, Qun, Shui, Yongjie, Shen, Li, Hu, Qiongge, Huang, Zhifei, Zhu, Shuangqiu, Jiang, Hao, Wei, Qichun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638122/
https://www.ncbi.nlm.nih.gov/pubmed/37848757
http://dx.doi.org/10.1007/s11060-023-04459-4
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author Yu, Yaner
Chen, Haiyan
Tian, Zhifeng
Zhang, Qun
Shui, Yongjie
Shen, Li
Hu, Qiongge
Huang, Zhifei
Zhu, Shuangqiu
Jiang, Hao
Wei, Qichun
author_facet Yu, Yaner
Chen, Haiyan
Tian, Zhifeng
Zhang, Qun
Shui, Yongjie
Shen, Li
Hu, Qiongge
Huang, Zhifei
Zhu, Shuangqiu
Jiang, Hao
Wei, Qichun
author_sort Yu, Yaner
collection PubMed
description PURPOSE: To investigate the impact of radiotherapy (RT) and immune checkpoint inhibitor (ICI) sequence on the survival outcome in NSCLC patients with brain metastasis, and decide the best time to initiate RT. METHODS: Patients were managed with delayed RT (ICI delivered over 2 weeks prior to RT), concurrent RT (ICI delivered within 2 weeks prior to or after RT), or upfront RT (RT delivered over 2 weeks prior to ICI). Overall survival (OS), intracranial local progression-free survival (iLPFS), and intracranial distant progression-free survival (iDPFS) were assessed. A meta-analysis was performed to analyze the association between survival outcome and RT/ICI sequence. RESULTS: A total of 73 NSCLC patients were identified with a median follow-up of 13.9 months. Patients who receive delayed RT demonstrated shorter iLPFS (P = 0.0029), iDPFS (P = 0.016), and OS (P < 0.001). A meta-analysis was conducted and a total of 4 studies, 254 patients were included. The HR was 0.44 for iDPFS (P = 0.03), 0.41 for OS (P < 0.01) when compared concurrent with delayed RT, 0.21 for iDPFS (P < 0.01), 0.32 for OS (P < 0.01) when compared upfront with delayed RT, consistent with our conclusion that delayed RT brought with worst iDPFS and OS. More importantly, the best overall response rate (BOR) decreased in cases with longer RT and ICI intervals. Patients who receive intervals of RT and ICI within 7 days achieve the best median BOR of − 53%. CONCLUSIONS: Delayed RT brought poor survival outcomes including iLPFS, iDPFS, and OS in NSCLC patients. The shorter interval of RT and ICI is associated with better BOR. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-023-04459-4.
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spelling pubmed-106381222023-11-14 Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases Yu, Yaner Chen, Haiyan Tian, Zhifeng Zhang, Qun Shui, Yongjie Shen, Li Hu, Qiongge Huang, Zhifei Zhu, Shuangqiu Jiang, Hao Wei, Qichun J Neurooncol Research PURPOSE: To investigate the impact of radiotherapy (RT) and immune checkpoint inhibitor (ICI) sequence on the survival outcome in NSCLC patients with brain metastasis, and decide the best time to initiate RT. METHODS: Patients were managed with delayed RT (ICI delivered over 2 weeks prior to RT), concurrent RT (ICI delivered within 2 weeks prior to or after RT), or upfront RT (RT delivered over 2 weeks prior to ICI). Overall survival (OS), intracranial local progression-free survival (iLPFS), and intracranial distant progression-free survival (iDPFS) were assessed. A meta-analysis was performed to analyze the association between survival outcome and RT/ICI sequence. RESULTS: A total of 73 NSCLC patients were identified with a median follow-up of 13.9 months. Patients who receive delayed RT demonstrated shorter iLPFS (P = 0.0029), iDPFS (P = 0.016), and OS (P < 0.001). A meta-analysis was conducted and a total of 4 studies, 254 patients were included. The HR was 0.44 for iDPFS (P = 0.03), 0.41 for OS (P < 0.01) when compared concurrent with delayed RT, 0.21 for iDPFS (P < 0.01), 0.32 for OS (P < 0.01) when compared upfront with delayed RT, consistent with our conclusion that delayed RT brought with worst iDPFS and OS. More importantly, the best overall response rate (BOR) decreased in cases with longer RT and ICI intervals. Patients who receive intervals of RT and ICI within 7 days achieve the best median BOR of − 53%. CONCLUSIONS: Delayed RT brought poor survival outcomes including iLPFS, iDPFS, and OS in NSCLC patients. The shorter interval of RT and ICI is associated with better BOR. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-023-04459-4. Springer US 2023-10-17 2023 /pmc/articles/PMC10638122/ /pubmed/37848757 http://dx.doi.org/10.1007/s11060-023-04459-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Yu, Yaner
Chen, Haiyan
Tian, Zhifeng
Zhang, Qun
Shui, Yongjie
Shen, Li
Hu, Qiongge
Huang, Zhifei
Zhu, Shuangqiu
Jiang, Hao
Wei, Qichun
Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title_full Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title_fullStr Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title_full_unstemmed Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title_short Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases
title_sort improved survival outcome with not-delayed radiotherapy and immediate pd-1/pd-l1 inhibitor for non-small-cell lung cancer patients with brain metastases
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638122/
https://www.ncbi.nlm.nih.gov/pubmed/37848757
http://dx.doi.org/10.1007/s11060-023-04459-4
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