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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Checkpoint inhibition for resected lung cancer brain metastases (LCBM) – a propensity-score matched pairs analysis

Immuncheckpoint-Inhibitoren bei Patienten mit Resektion von Hirnmetastasen bei Lungenkarzinom: eine Analyse mittels Propensity Score-Verfahren

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  • presenting/speaker David Wasilewski - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Josefine Radke - Charité – Universitätsmedizin Berlin, Neuropathologie, Berlin, Deutschland; Berlin Institute of Health (BIH), Berlin, Deutschland
  • Ran Xu - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Berlin Institute of Health (BIH), Berlin, Deutschland
  • Matthias Raspe - Charité – Universitätsmedizin Berlin, Infektiologie und Pneumologie, Berlin, Deutschland
  • Anna Trelinska-Finger - Charité – Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Deutschland
  • Tizian Rosenstock - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Berlin Institute of Health (BIH), Berlin, Deutschland
  • Paul Pöser - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Elisa Schumann - Charité – Universitätsmedizin Berlin, Neuropathologie, Berlin, Deutschland
  • Judith Lindner - Charité – Universitätsmedizin Berlin, Pathologie, Berlin, Deutschland
  • Frank Heppner - Charité – Universitätsmedizin Berlin, Neuropathologie, Berlin, Deutschland
  • David Kaul - Charité – Universitätsmedizin Berlin, Radioonkologie, Berlin, Deutschland
  • Norbert Suttorp - Charité – Universitätsmedizin Berlin, Infektiologie und Pneumologie, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Nikolaj Frost - Charité – Universitätsmedizin Berlin, Infektiologie und Pneumologie, Berlin, Deutschland
  • Julia Sophie Onken - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Andreas Wetzel-Yalelis - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP041

doi: 10.3205/22dgnc355, urn:nbn:de:0183-22dgnc3553

Published: May 25, 2022

© 2022 Wasilewski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Patients with LCBM have regularly been excluded from prospective clinical trials including therapy with immune checkpoint inhibitors (ICIs). Real-world data demonstrating the benefit of ICIs, specifically in patients following neurosurgical brain metastasis resection, are still scarce. Few reports exist on the comparison of radiation therapy with immune checkpoint inhibition (RT + ICI) versus classic therapy involving radiation therapy and chemotherapy (RT + CT) after surgery.

Methods: We performed a retrospective, single-center 1:1 propensity-matched comparative effectiveness study to assess the effect of treatment with RT + CT vs. RT + ICI in patients with resected lung cancer brain metastases.

Results: From 440 patients two cohorts of interest included 161 patients (36,6%) with RT + CT and 75 patients (17%) with RT + ICIs following neurosurgical BM removal. After PSM (74 patients per group) patients receiving RT + CT after neurosurgery had significantly decreased OS (10,4 months; 95% CI; 8,63 – 13,9 months) as compared to patients with RT + ICIs (27,6 months; 95% CI; 20,53 – not estimable (NE) months; p=0.00041). Multivariable Cox regression of matched patients identified prognostic factors: primary tumor resection (hazard ratio [HR] 0.39, 95% CI: 0.20-0.74, p=0.004), presence of extracranial metastases (HR 1,92, 95% CI: 1,16-3,17, p = 0.011) and RT + ICI following brain metastasis resection (HR 0.34, 95% CI: 0.21-0.55, p<0.001).

Conclusion: Patients with LCBM undergoing neurosurgical resection benefit from RT and ICIs following neurosurgical resection and show an increase in OS as compared to patients receiving platinum-based chemotherapy and radiation. Prospective studies in LCBM patients subjected to brain metastasis resection are needed. RT and ICIs should be regularly evaluated in an interdisciplinary team as a treatment option for patients with resectable LCBM.

Figure 1 [Fig. 1], Table 1 [Tab. 1]