Author of

• 35161

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  P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Locoregional and Oligometastatic Disease
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35175

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    P19.12 - Immunotherapy as Single Treatment for Brain Metastases of Non-small cell Lung Cancer: A Systematic Review and Meta-Analysis.  (ID 3511)

    00:00 - 00:00  |  Presenting Author(s): Viviane Teixeira Loiola de Alencar
    • Abstract
    • Presentation

    Introduction
    

    Brain metastases (BM) occur in approximately 40% of lung cancer patients along the course of their disease. Immunotherapy has changed the treatment landscape of non-small cell lung cancer (NSCLC) without an actionable driver gene mutation. Its activity in patients with BM, however, remains controversial, as the cornerstone treatment in this scenario is local treatment, especially radiotherapy (RDT). Since RDT is associated with adverse events that may impair quality of life, the possibility of substituting it by a single systemic approach is very attractive. Therefore, we performed a systematic review and meta-analysis to evaluate the potential benefit of immune checkpoint inhibitors (ICIs) in NSCLC patients with untreated BM (unBM).

    Methods
    

    Studies that enrolled NSCLC patients treated with ICIs and allowed for unBM, published or presented as abstracts in congresses or meetings from inception to April 2020 were identified by searching the Embase, PubMed, LILACS, Scopus and Cochrane Library databases. The outcomes evaluated were intracerebral overall response rate (ORR) and intracerebral disease control rate (iDCR) for unBM, as well as grades 3/4 toxicity rate and the rate of progression free survival (PFS) in 6 months, calculated through the inverse variance random-effect method for single arm. We also compared ORR and iDCR between patients with treated and untreated BM, using pooled risk ratios with the random effect model.

    Results
    

    We included 12 studies, n=566 individuals, in the final analysis. All patients were treated with anti-PD1 therapy. Most patients had adenocarcinoma histology and a good performance status; were current or former smokers; had up to 5 brain lesions and were asymptomatic from the BM. Anti-PD1 therapy appears to be active in the central nervous system, with a median ORR of 13.4% (95% IC 7.1% - 20.8%, p = 0.272) and a median iDCR of 38.3% (95% IC 27.1% - 50.1%, p = 0.195), with acceptable grades 3/4 toxicity rate (median value of 18.9%; 95% IC 10.1% – 29.2%; p = 0.767). In the meta-analysis for ORR (HR = 1.26, 95% IC: 0.57 - 2.79; p = 0.58) and iDCR (HR = 0.88, 95% IC: 0.55 - 1.43; p = 0.58) we did not observe any difference between patients with BM who were treated with RDT prior to ICI start and those who were treated with ICI only. Median PFS for unBM ranged from 1.1 to 2.3 months. PFS rate in 6 months was 30.4% (95% IC 22.9% – 38.6%, p< 0.001), with a high heterogeneity (I² = 85.41%).

    Conclusion
    

    ICIs appear to be effective as a single treatment for active BM in selected patients with advanced NSCLC. This approach not only delays side effects related to radiotherapy, but also allows for a sooner systemic management. Results from ongoing trials will help to more definitely clarify the role of immunotherapy in this scenario and who are the patients that will benefit the most.

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