Local Therapy for Isolated Central Nervous System Progression Among Patients Receiving Antibody-Drug Conjugate Therapy

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-03-01 DOI:10.1016/j.adro.2025.101714

Emily S. Lebow MD , Jordan Eichholz MS , Zhigang Zhang PhD , Nicolas Toumbacaris MSPH , Brandon Imber MD, MA , Linda Chen MD , Quincey LaPlant MD, PhD , Josh Yamada MD , Luke R.G. Pike MD, DPhil , Shanu Modi MD , Andrew D. Seidman MD , Kathryn Beal MD , Nelson S. Moss MD , Yao Yu MD

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引用次数: 0

Abstract

Purpose

Antibody drug conjugates (ADCs) are an increasingly important class of therapeutics among patients with breast, lung, urothelial, and other malignancies. Guidelines recommend local therapy and continuation of current systemic therapy among patients with isolated brain relapse. We describe the clinical outcomes of this approach among patients receiving ADCs.

Methods and Materials

We queried our institutional database for patients receiving radiation therapy (RT) in the setting of isolated brain progression on ADCs with a plan to continue same-line therapy after radiation. Patients with ≤3 brain metastases at the time of recurrence were categorized as oligoprogressive. Study endpoints included overall survival, progression-free survival (PFS), and the cumulative incidence of next therapy from the start of local therapy.

Results

We identified 17 patients receiving ADC therapy with isolated brain progression treated with radiation (stereotactic radiosurgery [SRS]: n = 13, whole brain radiation: n = 4). All patients received concurrent ADC and RT. The median follow-up from local therapy was 29.5 months (95% CI, 21.4-not reached). The median overall survival was 19 months (95% CI, 16-not reached), and the median PFS was 8.1 months (range, 6.7-19 months). One lesion treated with SRS had local failure 21 months after treatment, and the 24-month cumulative incidence of local failure across the entire cohort was 1.6% (95% CI, 0.13%-7.7%). The 6-month cumulative incidence of radiation necrosis was 12% (95% CI, 1.8%-32%). The cumulative incidence of next therapy at 6 and 12 months was 47% (95% CI, 22%-69%) and 71% (95% CI, 41%-87%), respectively, and was significantly lower among patients with oligoprogressive brain recurrence. After SRS, 2 patients were without evidence of disease, discontinued systemic therapy, and were stable on observation at last follow-up.

Conclusions

To the best of our knowledge, this is the first clinical report of outcomes using the guideline-recommended approach of local therapy for isolated brain relapse among patients receiving ADCs. Local therapy may delay the need for next line systemic therapy, particularly among patients with oligoprogressive brain relapse.

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接受抗体-药物偶联治疗的患者孤立性中枢神经系统进展的局部治疗

目的抗体药物偶联物（adc）在乳腺癌、肺癌、尿路上皮和其他恶性肿瘤的治疗中越来越重要。指南建议对孤立性脑复发患者进行局部治疗和继续目前的全身治疗。我们描述了这种方法在接受adc的患者中的临床结果。方法和材料我们查询了机构数据库中接受放射治疗（RT）的adc孤立脑进展患者，并计划在放射后继续进行同线治疗。复发时脑转移≤3个的患者被归类为少进展。研究终点包括总生存期、无进展生存期（PFS）和从局部治疗开始的下一次治疗的累积发生率。结果我们确定了17例接受ADC治疗的孤立性脑进展患者，放疗（立体定向放射外科[SRS]: n = 13，全脑放疗：n = 4）。所有患者同时接受ADC和rt。局部治疗的中位随访时间为29.5个月（95% CI， 21.4-未达到）。中位总生存期为19个月（95% CI， 16-未达到），中位PFS为8.1个月（范围6.7-19个月）。SRS治疗的一个病变在治疗21个月后出现局部衰竭，整个队列24个月局部衰竭的累积发生率为1.6% （95% CI, 0.13%-7.7%）。6个月累积放射性坏死发生率为12% （95% CI, 1.8%-32%）。6个月和12个月的累计下一次治疗发生率分别为47% （95% CI, 22%-69%）和71% (95% CI, 41%-87%)，在少进展性脑复发患者中显著降低。经SRS治疗后，2例患者无疾病迹象，停止全身治疗，最后随访观察病情稳定。据我们所知，这是首个使用指南推荐的局部治疗方法治疗adc患者孤立性脑复发的临床报告。局部治疗可能会延迟下一步全身治疗的需要，特别是在低进行性脑复发的患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.