Patients With NSCLC Brain Metastases Undergoing Neurosurgical Resection: Comparison of Treatment Regimens

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In a German single-institution retrospective cohort study reported in JAMA Network Open, Wasilewski et al found that treatment with immune checkpoint inhibition plus radiotherapy was associated with prolonged overall survival vs platinum-based chemotherapy plus radiotherapy in patients with brain metastases from non–small cell lung cancer (NSCLC) who were undergoing neurosurgical resection.

Study Details

The study included patients with NSCLC who had undergone craniotomy for brain metastases at the largest neurosurgical clinic in Germany (Charite University Medical Hospital, Berlin) between January 2010 and December 2021. Among 171 patients meeting eligibility requirements who received adjuvant immune checkpoint inhibition plus radiotherapy or chemotherapy plus radiotherapy, a 1:1 propensity score–matched cohort of 62 patients in each group was constructed after resection. Propensity matching involved the following factors:

  • Sex
  • Age
  • Number of brain metastases at baseline
  • Volume and location of brain metastases
  • Gradual prognostic assessment score
  • Status of extracranial disease burden
  • Mode of adjuvant radiation therapy
  • Status of primary tumor resection
  • Dose of adjuvant radiation therapy
  • Baseline Union for International Cancer Control stage.

Key Findings

Median follow-up was 47.9 months (interquartile range = 28.2–70.1 months). In the propensity score–matched cohort, median overall survival was 23.0 months (95% confidence interval [CI] = 20.3–53.8 months) in the immune checkpoint inhibitor plus radiotherapy group vs 11.8 months (95% CI = 9.1–15.2 months) in the chemotherapy plus radiotherapy group (P < .001).

On multivariate analysis, the only significant predictors of overall survival were treatment with immune checkpoint inhibition plus radiotherapy (hazard ratio [HR] = 0.34, 95% CI = 0.21–0.55, P < .001), primary tumor resection (HR = 0.39, 95% CI = 0.20–0.74, P = .004), and presence of extracranial metastases (HR = 1.92, 95% CI = 1.16–3.17, P = .01).

The investigators concluded, “Patients with NSCLC brain metastases undergoing neurosurgical resection had longer overall survival when treated with radiation therapy and immune checkpoint inhibitors following neurosurgery compared with those receiving platinum-based chemotherapy and radiation. Radiation and systemic immunotherapy should be regularly evaluated as a treatment option for these patients.”

Peter Vajkoczy, MD, and David Wasilewski, MD, of the Department of Neurosurgery, Charite-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, are the corresponding authors for the JAMA Network Open article.

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