Inflammation Flare and Radiation Necrosis Around a Stereotactic Radiotherapy-Pretreated Brain Metastasis Site After Nivolumab Treatment

Immunotherapy as Single Treatment for Patients With NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis-the META-L-BRAIN Study

INTRODUCTION

Brain metastases (BMs) occur in 40% of patients with lung cancer. The activity of immunotherapy in these patients, however, remains controversial, as the cornerstone treatment is radiotherapy (RT). Because RT is associated with adverse events that may impair the quality of life, the possibility of substituting it with a single systemic approach is attractive. Therefore, we performed a systematic review and meta-analysis to evaluate the potential benefit of immune checkpoint inhibitors (ICIs) in patients with NSCLC with untreated BM (unBM).

METHODS

Studies that enrolled patients with NSCLC treated with ICIs and specifically allowed for unBM were identified by searching the EMBASE, PubMed, Cochrane, and other databases. The outcomes evaluated were intracerebral overall response rate (icORR) and intracerebral disease control rate (icDCR) for unBM, and grades 3 and 4 toxicity rate.

RESULTS

We included 12 studies with a total of 566 individuals in the final analysis. Anti-programmed cell death protein-1 therapy seems to be active in the central nervous system, with an icORR of 16.4% (95% confidence interval [CI]: 9.8%-24%; I² = 33.17%) and an icDCR of 45% (95% CI: 33.4%-56.9%; I² = 46.91%). In the meta-analysis for icORR (risk ratio = 1.26, 95% CI: 0.57-2.79) and icDCR (risk ratio = 0.88, 95% CI: 0.55-1.43) we did not observe any difference among patients with BM who were treated with RT before ICI start and those who were treated with ICI only.

CONCLUSIONS

ICI seems to be effective as a single treatment for active BM in selected patients with advanced NSCLC.

Statistical fundamentals on cancer research for clinicians: Working with your statisticians

PURPOSE

To facilitate understanding statistical principles and methods for clinicians involved in cancer research.

METHODS

An overview of study design is provided on cancer research for both observational and clinical trials addressing study objectives and endpoints, superiority tests, non-inferiority and equivalence design, and sample size calculation. The principles of statistical models and tests including contemporary standard methods of analysis and evaluation are discussed. Finally, some statistical pitfalls frequently evident in clinical and translational studies in cancer are discussed.

RESULTS

We emphasize the practical aspects of study design (superiority vs non-inferiority vs equivalence study) and assumptions underpinning power calculations and sample size estimation. The differences between relative risk, odds ratio, and hazard ratio, understanding outcome endpoints, purposes of interim analysis, and statistical modeling to minimize confounding effects and bias are also discussed.

CONCLUSION

Proper design and correctly constructed statistical models are critical for the success of cancer research studies. Most statistical inaccuracies can be minimized by following essential statistical principles and guidelines to improve quality in research studies.

Can radiation-recall predict long lasting response to immune checkpoint inhibitors?

RR secondary to ICI (nivolumab in all patients) were observed in the lung (n = 1) or skin (n = 3). All patients had a long-term response to ICI and are currently alive with no active disease (Median FU from ICI discontinuation: 30 months). RR could reflect a beneficial immune activation and constitute a predictive clinical biomarker of ICI long-term efficacy.