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Distant brain failure after stereotactic radiosurgery for brain metastases in patients receiving novel systemic
Paul van Schie1,2, Ruben G Huisman3, Terry Wiersma3
1Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
Background:
Novel systemic therapies, such as immunotherapy and targeted therapies, have shown better systemic disease control in the last decennium. However, the effect of these treatments on distant brain failure (DBF) in patients with brain metastases (BM) remains a topic of discussion. Improving time to DBF leads to longer overall survival (OS), as is reflected in the brain metastasis velocity (BMV). This study presents real world data about the combined effects of local and systemic treatments on DBF and survival.
Methods:
A retrospective consecutive cohort study was conducted. Patients with newly diagnosed BM were included between June 2018 and May 2020. Factors associated with DBF were analyzed in multivariate models. The association between BMV and overall survival was analyzed with linear regression analysis.
Results:
Three hundred and three patients were included. Two hundred and sixty-two (86%) patients received stereotactic radiotherapy, 41 (14%) awaited in first instance the intracranial effect of newly started or switched systemic treatment. Median time to DBF after radiotherapy was 21 months (95% CI 15-27), median OS was 20 months (IQR 10-36). Receiving immunotherapy or targeted therapy were associated with a lower hazard of DBF, compared with chemotherapy. The presence of > 5 initial BM and progressive or stable extracranial disease were associated with increased DBF. BMV was significantly associated with overall survival.
Conclusions:
In this retrospective cohort, patients who received immunotherapy or targeted therapy experienced a reduced risk of DBF in comparison to those treated with chemotherapy. A higher BMV was associated with a decreased OS.
Insights
Novel systemic therapies like immunotherapy and targeted therapy reduce the risk of distant brain failure (DBF) in patients with brain metastases (BM). Higher brain metastasis velocity (BMV) is linked to shorter overall survival (OS).
Area of Science:
- Neuro-oncology
- Medical oncology
- Radiation oncology
Background:
- Systemic therapies, including immunotherapy and targeted therapy, have improved systemic disease control for brain metastases (BM).
- The impact of these novel treatments on distant brain failure (DBF) and overall survival (OS) in BM patients requires further investigation.
- Brain metastasis velocity (BMV) is a potential indicator of treatment efficacy and patient outcomes.
Purpose of the Study:
- To evaluate the real-world effects of combined local and systemic treatments on DBF and OS in patients with BM.
- To compare the efficacy of immunotherapy and targeted therapy versus chemotherapy in reducing DBF.
- To analyze the association between BMV and OS in BM patients.
Main Methods:
- Retrospective consecutive cohort study of 303 patients with newly diagnosed BM (June 2018 - May 2020).
- Analysis of factors associated with DBF using multivariate models.
- Linear regression analysis to assess the association between BMV and OS.
Main Results:
- Immunotherapy or targeted therapy was associated with a lower hazard of DBF compared to chemotherapy.
- The presence of >5 initial BM and progressive or stable extracranial disease increased DBF risk.
- Median time to DBF after radiotherapy was 21 months; median OS was 20 months.
- BMV was significantly associated with overall survival.
Conclusions:
- Immunotherapy and targeted therapy demonstrate a reduced risk of DBF in BM patients compared to chemotherapy.
- Higher BMV is associated with decreased overall survival, highlighting its prognostic significance.
