Addition of Immunotherapy to Other Treatments in Patients With Brain Metastases After Definitive Surgery

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In a National Cancer Database analysis reported in JAMA Network Open, Amin et al found that among patients with brain metastases who underwent definitive surgery for primary tumors, the combination of immunotherapy and radiotherapy prolonged overall survival compared with radiotherapy alone.

Study Details

The study involved data from 3,112 adult patients with non–small cell lung cancer, breast cancer, melanoma, colorectal cancer, or kidney cancer and brain metastases at the time of diagnosis who received definitive surgery of the primary cancer site. Data were collected over a 6-year period.

Key Findings

Overall, 183 patients (5.9%) received immunotherapy; 318 (10.2%) received chemotherapy alone; 788 (25.3%) received radiotherapy alone; 1,393 (44.8%) received chemoradiation alone; 22 (6.5%) received chemotherapy plus immunotherapy; 72 (8.4%) received radiotherapy plus immunotherapy; and 76 (5.2%) received chemoradiation plus immunotherapy.

On multivariate analysis of factors associated with overall survival, treatment factors associated with improved survival were receipt of immunotherapy vs no immunotherapy (hazard ratio [HR] = 0.62, P = .001) and receipt of chemotherapy vs no chemotherapy (HR = 0.68, P = .001). No difference was observed for receipt of radiotherapy vs no radiotherapy (HR = 0.94, P = .21).

On multivariate analysis of combining immunotherapy with chemotherapy or radiotherapy, immunotherapy plus radiotherapy was associated with improved survival vs radiotherapy alone (HR = 0.59, P = .003), whereas no significant differences were observed for chemotherapy plus immunotherapy vs chemotherapy alone (HR = 0.79, P = .43) or for chemoradiation plus immunotherapy vs chemoradiation alone (HR = 0.75, P = .07).

The investigators concluded: “In this study, the addition of immunotherapy to radiotherapy was associated with improved overall survival compared with radiotherapy alone in patients with brain metastases who received definitive surgery of the primary tumor site.”

Chi Lin, MD, PhD, of the Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit