Immunotherapy With Radiotherapy for Brain Metastases in Patients With NSCLC: NEJ060

Takehiro Tozuka, MD; Yuji Minegishi, MD, PhD; Ou Yamaguchi, MD, PhD; Kana Watanabe, MD; Yukihiro Toi, MD; Ryota Saito, MD, PhD; Yoshiaki Nagai, MD, PhD; Yosuke Tamura, MD, PhD; Tetsuaki Shoji, MD, PhD; Haruka Odagiri, MD; Noriyuki Ebi, MD; Kosuke Sakai, MD, PhD; Nobuhiro Kanaji, MD, PhD; Makoto Izumi, MD; Sayo Soda, MD, PhD; Satoshi Watanabe, MD, PhD; Satoshi Morita, PhD; Kunihiko Kobayashi, MD, PhD; Masahiro Seike, MD, PhD

JTO Clinical and Research Reports (Apr 2024)

Immunotherapy With Radiotherapy for Brain Metastases in Patients With NSCLC: NEJ060

Takehiro Tozuka, MD,
Yuji Minegishi, MD, PhD,
Ou Yamaguchi, MD, PhD,
Kana Watanabe, MD,
Yukihiro Toi, MD,
Ryota Saito, MD, PhD,
Yoshiaki Nagai, MD, PhD,
Yosuke Tamura, MD, PhD,
Tetsuaki Shoji, MD, PhD,
Haruka Odagiri, MD,
Noriyuki Ebi, MD,
Kosuke Sakai, MD, PhD,
Nobuhiro Kanaji, MD, PhD,
Makoto Izumi, MD,
Sayo Soda, MD, PhD,
Satoshi Watanabe, MD, PhD,
Satoshi Morita, PhD,
Kunihiko Kobayashi, MD, PhD,
Masahiro Seike, MD, PhD

Affiliations

Takehiro Tozuka, MD: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
Yuji Minegishi, MD, PhD: Department of Respiratory Medicine, Mitsui. Memorial Hospital, Tokyo, Japan
Ou Yamaguchi, MD, PhD: Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Kana Watanabe, MD: Department of Respiratory Medicine, Miyagi Cancer Center, Miyagi, Japan
Yukihiro Toi, MD: Department of Pulmonary Medicine, Sendai Kousei Hospital, Miyagi, Japan
Ryota Saito, MD, PhD: Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Yoshiaki Nagai, MD, PhD: Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Japan
Yosuke Tamura, MD, PhD: Department of Respiratory Medicine and Thoracic Oncology, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
Tetsuaki Shoji, MD, PhD: Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
Haruka Odagiri, MD: Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
Noriyuki Ebi, MD: Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
Kosuke Sakai, MD, PhD: Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Nobuhiro Kanaji, MD, PhD: Department of Internal Medicine, Division of Hematology, Rheumatology, and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
Makoto Izumi, MD: Department of Chemotherapy, Yokosuka Kyosai Hospital, Kanagawa, Japan
Sayo Soda, MD, PhD: Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
Satoshi Watanabe, MD, PhD: Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Satoshi Morita, PhD: Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
Kunihiko Kobayashi, MD, PhD: Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Masahiro Seike, MD, PhD: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Corresponding author. Address for correspondence: Masahiro Seike MD, PhD, Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.

Journal volume & issue: Vol. 5, no. 4
p. 100655

Abstract

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Introduction: Immune checkpoint inhibitor (ICI)–based treatment has become standard treatment for patients with advanced NSCLC. We aimed to determine the survival benefit of upfront radiotherapy for brain metastases (BMs) in patients with NSCLC who received ICI alone (ICI-alone) or with chemotherapy (ICI-chemo). Methods: This study included consecutive patients with NSCLC having BMs who received ICI alone or ICI-chemo at 50 institutes between February 2017 and September 2021. The presence of BMs was confirmed by imaging before treatment. Treatment outcomes were compared between patients who did and did not receive upfront radiotherapy for BMs. Potential confounding factors were adjusted between the groups through inverse probability treatment weighting (IPTW) analysis and overlap weighting (OW) analysis with propensity scores. Results: Patients were grouped as ICI-alone cohort, 224 patients (upfront-radiotherapy group, 135 patients; no-radiotherapy group, 89 patients) and ICI-chemo cohort, 367 patients (upfront-radiotherapy group, 212 patients; no-radiotherapy group, 155 patients). In the ICI-alone cohort, the overall survival of the upfront-radiotherapy group was significantly longer than that of the no-radiotherapy group (IPTW-adjusted hazards ratio [HR] = 0.45 [95% confidence interval [CI]: 0.29–0.72], OW-adjusted HR = 0.52 [95% CI: 0.35–0.77]). In contrast, in the ICI-chemo cohort, the OS of the upfront-radiotherapy group was not significantly different from that of the no-radiotherapy group (IPTW-adjusted HR = 1.02 [95% CI: 0.70–1.48], OW-adjusted HR = 0.93 [95% CI: 0.65–1.33]). Conclusions: Upfront radiotherapy for BMs was associated with longer overall survival in patients with NSCLC who received ICI alone; however, it did not exhibit survival benefits in the patients who received ICI-chemo.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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