1. Outcome of Patients with Non-Small Cell Lung Cancer and Brain Metastases Treated with Checkpoint Inhibitors
- Author
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Cécile Le Péchoux, Anne-Marie C. Dingemans, Laura Mezquita, Boris Duchemann, Emmanuèle Lechapt, Clarisse Audigier-Valette, Clemence Henon, Sophie Cousin, Lizza E.L. Hendriks, Samy Ammari, David Planchard, Anas Gazzah, Corentin Lefebvre, Caroline Caramella, Dirk De Ruysscher, Roberto Ferrara, Julien Mazieres, Angela Botticella, Edouard Auclin, Julien Adam, Audrey Rabeau, Sylvestre Le Moulec, Benjamin Besse, Pulmonologie, Promovendi ODB, MUMC+: MA Med Staf Spec Longziekten (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Radiotherapie
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0301 basic medicine ,Male ,Lung Neoplasms ,Programmed Cell Death 1 Receptor ,Pembrolizumab ,NSCLC ,Gastroenterology ,B7-H1 Antigen ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,Disease specific Graded Prognostic Assessment ,Carcinoma, Non-Small-Cell Lung ,Checkpoint inhibition ,Medicine ,Aged, 80 and over ,DOCETAXEL ,Brain Neoplasms ,Middle Aged ,Prognosis ,OPEN-LABEL ,Survival Rate ,Oncology ,Docetaxel ,030220 oncology & carcinogenesis ,Cohort ,Carcinoma, Squamous Cell ,Female ,Nivolumab ,medicine.drug ,Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Adenocarcinoma of Lung ,survival ,03 medical and health sciences ,Internal medicine ,PATIENTS PTS ,Humans ,Lung cancer ,PEMBROLIZUMAB ,Pseudoprogression ,Aged ,Retrospective Studies ,business.industry ,Proportional hazards model ,NIVOLUMAB ,Brain metastases ,medicine.disease ,EFFICACY ,Confidence interval ,LIFE ,030104 developmental biology ,business ,SYSTEM ,Follow-Up Studies - Abstract
Introduction: Although frequent in NSCLC, patients with brain metastases (BMs) are often excluded from immune checkpoint inhibitor (ICI) trials. We evaluated BM outcome in a less-selected NSCLC cohort.Methods: Data from consecutive patients with advanced ICI-treated NSCLC were collected. Active BMs were defined as new and/or growing lesions without any subsequent local treatment before the start of ICI treatment. Objective response rate (ORR), progression-free survival, and overall survival (OS) were evaluated. Multivariate analyses were performed by using a Cox proportional hazards model and logistic regression.Results: A total of 1025 patients were included; the median follow-up time from start of ICI treatment was 15.8 months. Of these patients, 255 (24.9%) had BMs (39.2% active, 14.3% symptomatic, and 27.4% being treated with steroids). Disease-specific Graded Prognostic Assessment (ds-GPA) score was known for 94.5% of patients (35.7% with a score of 0-1, 58.5% with a score of 1.5-2.5, and 5.8% with a score of 3). The ORRs with BM versus without BM were similar: 20.6% (with BM) versus 22.7% (without BM) (p = 0.484). The intracranial ORR (active BM with follow-up brain imaging [n = 73]) was 27.3%. The median progression-free survival times were 1.7 (95% confidence interval [CI]: 1.5-2.1) and 2.1 (95% CI: 1.9-2.5) months, respectively (p = 0.009). Of the patients with BMs, 12.7% had a dissociated cranial-extracranial response and two (0.8%) had brain pseudoprogression. Brain progression occurred more in active BM than in stable BM (54.2% versus 30% [p Conclusion: In multivariate analysis BMs are not associated with a poorer survival in patients with ICI-treated NSCLC. Stable patients with BM without baseline corticosteroids and a good ds-GPA classification have the best prognosis. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
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- 2019
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