Efficacy of immune checkpoint inhibitors in patients with brain metastasis from NSCLC, RCC, and melanoma.

Authors

null

Adam Lauko

Cleveland Clinic Lerner College of Medicine, Cleveland, OH

Adam Lauko, Bicky Thapa, Xuefei Jia, Manmeet Singh Ahluwalia

Organizations

Cleveland Clinic Lerner College of Medicine, Cleveland, OH, Cleveland Clinic Fairview Hospital, Cleveland, OH, Cleveland Clinic, Cleveland, OH

Research Funding

Other

Background: Immune checkpoint inhibitors are revolutionizing the treatment of multiple advanced malignancies, however, there is limited data on the efficacy of immune checkpoint blockade in brain metastasis. We conducted a study to analyze the overall survival (OS) and progression-free survival (PFS) among patients with brain metastasis from Non-Small Cell Lung Carcinoma (NSCLC), Renal Cell Carcinoma (RCC), and Melanoma treated with either Nivolumab, Pembrolizumab, Ipilimumab or a combination. Methods: After IRB approval, we retrospectively evaluated patients with brain metastasis treated at our tertiary care institution from 2011-2017 who underwent immunotherapy and one or more of the following; whole brain radiation therapy (WBRT), surgery, stereotactic radiosurgery (SRS) or systemic chemotherapy. Univariable and multivariable analysis was utilized to analyze OS and PFS. Volumetric analysis to assess treatment response is ongoing. Results: A total of 128 patients were identified with a median age of 60.6 years. 49% of patients were male; 77% of patients had a good (0 or 1) ECOG performance scores at the time of the brain metastasis; 83 patients had supratentorial brain metastasis, 11 had infratentorial and 24 had both. The prevalence of mutations was 34% in NSCLC patients, 58% in melanoma, and 0% in RCC. The median OS from the start of immunotherapy was not reached for RCC and was 17.1 and 28.9 months for Melanoma and NSCLC respectively. Median PFS was 5.9, 6.7 and 3.6 months for RCC, Melanoma, and NSCLC respectively. On multivariable analysis, SRS, sex and the number of cycles of immunotherapy had statistically significant hazard ratios. Conclusions: Immune checkpoint inhibitors are efficacious in the treatment of brain metastasis. Further analysis including response criteria using volumetric analysis is ongoing and final results will be presented at the meeting.

Primary CancerNo. PatientsEstimated Median (months)P-Value
(Log-Rank Test)
1-year survival rate
OS from start of immunotherapy.4041
RCC15Not reached55.4% ± 13.9
Melanoma1916.454.5% ± 11.9
NSCLC9411.048.3% ± 11.4
PFS from start of Immunotherapy
RCC155.9.06842.4% ± 13.5
Melanoma196.731.1% ± 11.5
NSCLC943.621.0% ± 8.9

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Abstract Details

Meeting

2018 ASCO-SITC Clinical Immuno-Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Developmental Therapeutics,Genitourinary Cancer,Head and Neck Cancer,Lung Cancer,Melanoma/Skin Cancers,Gastrointestinal Cancer,Breast and Gynecologic Cancers,Combination Studies,Implications for Patients and Society,Miscellaneous Cancers,Oncolytic Viruses,Hematologic Malignancies

Sub Track

Immune Checkpoints and Stimulatory Receptors

Citation

J Clin Oncol 36, 2018 (suppl 5S; abstr 214)

DOI

10.1200/JCO.2018.36.5_suppl.214

Abstract #

214

Poster Bd #

M4

Abstract Disclosures