Title
Stereotactic radiosurgery and immune checkpoint inhibitors in the management of brain metastases
Date Issued
01 January 2018
Access level
open access
Resource Type
review
Author(s)
Lehrer E.J.
McGee H.M.
Peterson J.L.
Vallow L.
Zaorsky N.G.
Sharma S.
Trifiletti D.M.
Mayo Clinic
Publisher(s)
MDPI AG
Abstract
Brain metastases traditionally carried a poor prognosis with an overall survival of weeks to months in the absence of treatment. Radiation therapy modalities include whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS). WBRT delivers a relatively low dose of radiation, has neurocognitive sequelae, and has not been investigated for its immunostimulatory effects. Furthermore, WBRT exposes the entire intracranial tumor immune microenvironment to radiation. SRS delivers a high dose of conformal radiation with image guidance to minimize dose to surrounding normal brain tissue, and appears to promote anti-tumor immunity. In parallel with many of these discoveries, immune checkpoint inhibitors (ICIs) have demonstrated a survival advantage in multiple malignancies commonly associated with brain metastases (e.g., melanoma). Combination SRS and ICI are theorized to be synergistic in anti-tumor immunity directed to brain metastases. The purpose of this review is to explore the synergy of SRS and ICIs, including pre-clinical data, existing clinical data, and ongoing prospective trials.
Volume
19
Issue
10
Language
English
OCDE Knowledge area
OncologĂa
NeurologĂa clĂnica
RadiologĂa, Medicina nuclear, ImĂ¡genes mĂ©dicas
Subjects
Scopus EID
2-s2.0-85054772596
PubMed ID
Source
International Journal of Molecular Sciences
ISSN of the container
16616596
DOI of the container
10.3390/ijms19103054
Source funding
AstraZeneca
Sponsor(s)
Conflicts of Interest: The authors declare no conflict of interest. H.M.M. was a former advisory board member for AstraZeneca; D.M.T. received clinical research funding from Novocure. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.
Sources of information:
Directorio de ProducciĂ³n CientĂfica
Scopus