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Title: Impact of Radiotherapy on the Efficacy and Toxicity of anti-PD-1 Inhibitors in Metastatic NSCLC.
Austin Authors: Samuel, Evangeline;Lie, Gabrielle ;Balasubramanian, Adithya ;Hiong, Alison;So, Yeojeong;Voskoboynik, Mark;Moore, Maggie;Shackleton, Mark;Haydon, Andrew;John, Tom;Mitchell, Paul L R ;Markman, Ben;Briggs, Peter;Parakh, Sagun 
Affiliation: School of Clinical Sciences, Monash University, Melbourne, Australia
Department of Medical Oncology, Monash Health, Clayton, Melbourne, Australia
Medical Oncology
School of Clinical Sciences, Monash University, Melbourne, Australia.
Department of Medical Oncology, Alfred Health, Melbourne, Australia
Issue Date: 10-Jun-2020 2020-06-10
Publication information: Clinical Lung Cancer 2020; online first: 10 June
Abstract: The impact of radiotherapy (RT) on the efficacy and toxicity of immune checkpoint inhibitors (ICIs) in patients with metastatic non-small-cell lung cancer (NSCLC) is unclear. We identified patients with metastatic NSCLC treated with the anti-programmed death 1 antibodies nivolumab or pembrolizumab between January 2016 and May 2019 at 3 tertiary centers, who were also treated with palliative RT either during or within 3 months of starting anti-programmed death 1 treatment. Patient demographics, tumor characteristics, and treatment history were collected. Response rates, progression-free survival (PFS), and overall survival (OS) were analyzed and correlated with RT use. A total of 269 patients were identified, with a median follow-up of 19.4 months. The median age was 70 years (range, 35-90 years), and they were 63% male, 60% smokers, and 65% had adenocarcinoma histology. At the commencement of ICI treatment, the majority (86%) had ≥ 1 line of prior therapy and 34% had brain metastases. A total of 102 (38%) patients received RT within 3 months of starting ICI or subsequently during ICI treatment. Of patients that received RT, 86 (84%) received conventional hypofractionated RT, and, in the majority, 81 (79%) the intent of RT was symptom control. The use of RT did not increase grade 3/4 immune-related adverse events. The overall median PFS was 2.0 months (95% confidence interval, 1.3-2.6 months) and the median OS was 9.0 months (95% confidence interval, 6.4-9.5 months). There were no significant differences in median PFS (3.0 vs. 2.0 months; P = .515) and median OS (9.0 vs. 9.0 months; P = .917) in the patients who received RT versus those that did not. In patients with metastatic NSCLC, the addition of RT to ICI was not associated with increased toxicity or improved survival.
DOI: 10.1016/j.cllc.2020.06.001
PubMed URL: 32778511
Type: Journal Article
Subjects: Abscopal effect
Immune related adverse events
Metastatic NSCLC
anti- PD-1 inhibitors
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