First-line immunotherapy ± chemotherapy with or without upfront stereotactic radiotherapy (SRT) in patients with Non-Small cell lung cancer (NSCLC) with asymptomatic brain metastases
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The role and optimal timing of SRT for patients with advanced NSCLC and asymptomatic brain metastases treated with immune checkpoint inhibitors (ICI) are controversial. METHODS: Efficacy and safety outcomes of patients with newly diagnosed non oncogene- addicted NSCLC with asymptomatic brain metastases (1-10 lesions, max. diameter of lesions 3 cm) treated with a first-line ICI-containing regimen at 11 Swiss cancer centers were retrospectively analyzed. RESULTS: A total of 128 patients in two cohorts (58 patients with upfront SRT and 69 patients without upfront SRT) were included in this analysis. The median intracranial progression-free survival (PFS) was significantly longer in patients with upfront SRT (12.6 vs. 8.2 months, Hazard ratio (HR) 0.62 [95 % CI 0.41 vs. 0.95], p = 0.026). This benefit remained significant after correcting for number and size of lesions and programmed cell death 1 ligand (PD-L1) status. The proportion of patients with symptomatic progression of brain metastases and of patients receiving further local treatment to the brain was similar between cohorts (3 % vs. 12 %, p = 0.11 and 33 % vs. 42 %, p = 0.3). No significant difference in median overall survival (OS) was observed between the cohorts (22.8 vs. 21.7 months, p = 0.4). Only two patients with upfront SRT experienced a clinically significant Central Nervous System (CNS) adverse event (AE). CONCLUSION: In this multicentric retrospective analysis of patients with asymptomatic brain metastases upfront SRT was associated with an improved intracranial PFS and was well tolerated but median OS and the rate of patients developing symptomatic brain progression were similar to patients without upfront SRT.
Source: Lung Cancer
Authors: Lorenz Frehner, Sämi Schär, Stefanie Hayoz, Verena Petermichl, Philip Speicher, Sacha I. Rothschild, Laetitia A. Mauti, David König, Tobias Finazzi, Patrizia Froesch, Sabrina Marini, Anna Allemann, Michael Mark, Wolf-Dieter Janthur, Antonia Stamatiou, Yannis Metaxas, Ekin Ermiş, Franca Wagner, Martin Früh, Sabine Schmid
Institutions: University of Bern, University Hospital of Bern, Kantonsspital St. Gallen, Kantonsspital Baden, Kantonsspital Winterthur, University Hospital of Basel, Ente Ospedaliero Cantonale, Istituto Oncologico della Svizzera Italiana, Luzerner Kantonsspital, Kantonsspital Graubünden, Kantonsspital Aarau, Centre Hospitalier Universitaire Vaudois, Kantonsspital Münsterlingen
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,390
OpenAlex ID: W4415817076