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Stereotactic radiosurgery with immunotherapy is associated with improved overall survival in patients with metastatic melanoma or non-small cell lung cancer: a National Cancer Database analysis

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Abstract

Purpose

Immunotherapy is now a first-line treatment for metastatic non-small cell lung cancer (NSCLC) and melanomaQuery. It is important to understand the relationship between immunotherapy and radiation to the brain. The aim of this study was to assess the role of stereotactic radiosurgery (SRS) or WBRT in addition to immunotherapy in patients with melanoma or NSCLC metastatic to the brain.

Methods/patients

Using the National Cancer Database, 2951 patients with NSCLC and 936 patients with melanoma treated with immunotherapy were identified. Patients were classified as having received immunotherapy alone, immunotherapy with SRS, or immunotherapy with whole-brain radiation therapy (WBRT). Kaplan–Meier, multivariate Cox regression analyses, and propensity matching were performed to evaluate the impact of adding SRS to immunotherapy on overall survival (OS). Immortal survival bias was accounted for by only including patients who received radiation before immunotherapy and time zero was defined as the start of immunotherapy.

Results

205(6.9%) and 75(8.0%) patients received immunotherapy with no radiation, 822(27.9%) and 326(34.8%) received SRS and immunotherapy, and 1924(65.2%) and 535(57.2%) received WBRT and immunotherapy for NSCLC and melanoma, respectively. Adding SRS to immunotherapy was associated with improved OS in multivariate analyses (NSCLC HR = 0.81, 95% CI 0.66–0.99, p = 0.044; melanoma HR = 0.63, 95% CI 0.45–0.90, p = 0.011). The addition of WBRT to immunotherapy did not improve OS in patients with melanoma nor NSCLC.

Conclusions

This analysis suggests that treatment with SRS and immunotherapy is associated with improved OS compared to immunotherapy alone for patients with melanoma or NSCLC metastatic to the brain.

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Availability of data and material

The datasets generated during and/or analysed during the current study are available in the National Cancer Database.

Code availability

The STATA code used for this project is available upon request.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA

    J. M. Jiang, R. Kabarriti, N. P. Brodin, N. Ohri, C. Guha, S. Kalnicki & M. Garg

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  1. J. M. Jiang
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  2. R. Kabarriti
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  3. N. P. Brodin
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  4. N. Ohri
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  5. C. Guha
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  6. S. Kalnicki
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  7. M. Garg
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Contributions

All authors contributed to the study conception and design. Material preparation and data analysis were performed by JJ. The first draft of the manuscript was written by JJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to R. Kabarriti.

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Conflict of interest

Dr Ohri reported receiving personal fees from Merck, AstraZeneca, and Johnson & Johnson outside the submitted work. Dr Guha reported receiving grants from the National Institutes of Health and Celldex Therapeutics, grants and personal fees from Johnson & Johnson, personal fees from Varian Medical Systems, and serves on the advisory board for Focused Ultrasound Foundation outside the submitted work. The other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This is a retrospective study using a de-identified dataset. This study was exempt from institutional review board approval.

Research involving human participants and/or animals

Given its retrospective nature and de-identified dataset, this study was exempt from institutional review board approval.

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Jiang, J.M., Kabarriti, R., Brodin, N.P. et al. Stereotactic radiosurgery with immunotherapy is associated with improved overall survival in patients with metastatic melanoma or non-small cell lung cancer: a National Cancer Database analysis. Clin Transl Oncol 24, 104–111 (2022). https://doi.org/10.1007/s12094-021-02675-w

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  • DOI: https://doi.org/10.1007/s12094-021-02675-w

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