Radiation therapy and other local therapies for brain metastases are associated with neurotoxic effects; cytotoxic chemotherapy, for its part, has shown limited effectiveness due to inability to cross the blood-brain barrier.
Immunotherapy has been shown to control intracranial metastases in patients with melanoma, but whether immunotherapy is effective in other cancers remains uncertain, Dr. Chi Lin and colleagues from the University of Nebraska Medical Center, in Omaha, note in in JAMA Network Open.
The team used data from the National Cancer Database to evaluate whether the use of immunotherapy in patients with brain metastases who received surgery of the primary site is associated with improved overall survival.
The study included more than 3,100 patients diagnosed with non-small-cell lung cancer, melanoma, breast cancer, colorectal cancer, or kidney cancer. Of these, 6% received immunotherapy, 6% received chemotherapy plus immunotherapy, 8% received radiation therapy plus immunotherapy, 5 % received chemoradiation plus immunotherapy, 10% received chemotherapy alone, 25% received radiation therapy alone, and 45% received chemoradiation alone.
Median overall survival was 22.6 months among patients who received immunotherapy versus 15.1 months among those who did not (P<0.001).
Similarly, median overall survival was significantly longer in patients who received radiotherapy plus immunotherapy (20.5 months) than in those who received radiotherapy alone (10.1 months) and in patients who received chemoradiation plus immunotherapy (28.5 months) than in those who received chemoradiation only (20.2 months).
The addition of immunotherapy to chemotherapy was not associated with a survival benefit.
On multivariable analysis, immunotherapy was associated with a 38% reduction in the risk of dying versus no immunotherapy (P<0.001), and immunotherapy plus radiation therapy was associated with a 41% reduction versus radiation therapy alone (P=0.003).
The addition of immunotherapy did not confer a survival advantage over chemotherapy or chemoradiation alone in the multivariable analysis.
Other factors associated with improved overall survival included younger age, treatment at an academic hospital, comorbidity score of 0, receiving chemotherapy, and having non-small-cell lung cancer (versus other cancers).
"The findings warrant future clinical trials investigating the association of chemotherapy, radiation therapy, and chemoradiation combined with immunotherapy with the survival of patients who receive definitive surgery of the primary tumor," the authors conclude.
Dr. Lin did not respond to a request for comments.
By Reuters Staff
SOURCE: https://bit.ly/3hjjuLw JAMA Network Open, online September 9, 2020.
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