Lung Stereotactic Body Radiotherapy and Concurrent Immunotherapy

Lung Stereotactic Body Radiotherapy and Concurrent Immunotherapy: A Multi-Center Safety and Toxicity Analysis.:

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Lung Stereotactic Body Radiotherapy and Concurrent Immunotherapy: A Multi-Center Safety and Toxicity Analysis.

Int J Radiat Oncol Biol Phys. 2020 Jan 23;:

Authors: Tian S, Switchenko JM, Buchwald ZS, Patel PR, Shelton JW, Kahn SE, Pillai RN, Steuer CE, Owonikoko TK, Behera M, Curran WJ, Higgins KA

Abstract

BACKGROUND: Radical treatment of metastases with stereotactic body radiotherapy (SBRT) is commonly implemented in patients receiving concurrent immune checkpoint inhibition (ICI), despite limited safety and toxicity data. The purpose of this study was to evaluate the safety and tolerability of lung SBRT with concurrent ICI.

METHODS: Records from a single academic institution were reviewed to identify patients treated with lung SBRT and concurrent (within 30 days) ICI; a contemporaneous cohort receiving lung SBRT alone was included for reference. Treatment-related adverse-effects (AE) occurring within 30 days (acute) and 180 days (subacute) of SBRT were evaluated.

RESULTS: 117 patients were included; 54 received SBRT with concurrent ICI (56 courses, 69 target lesions) and 63 received SBRT alone (68 courses, 79 lesions). Median follow-up was 9.2 months in the SBRT+ICI cohort. 67.9% received ICI monotherapy, 17.9% ICI/chemotherapy, and 14.3% ICI/ICI combinations. 25% received ICI between SBRT fractions; 42.9% received ICI both before and after SBRT. The risk of grade 3 (G3) pneumonitis was higher in the SBRT+ICI vs SBRT alone cohort (10.7% vs 0%, p<0.01); while any-grade pneumonitis was similar (33.9% vs 27.9%, SBRT+ICI vs SBRT, p=0.47). The risk of any-grade pneumonitis appeared elevated with ICI/ICI combinations (62.5% vs 29.2%). Receipt of ICI, PTV volume and lobes involved by SBRT were linked to high-grade pneumonitis. Subacute G3+ AEs occurred in 26.8% of SBRT+ICI and 2.9% of SBRT-alone patients.

CONCLUSIONS: Concurrent lung SBRT+ICI overall is safe. Given the clinically meaningful risk of pneumonitis, closer monitoring should be considered for SBRT+ICI patients, especially those receiving RT with ICI/ICI combinations.

PMID: 31982496 [PubMed - as supplied by publisher]