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Incidence, features and management of radionecrosis in melanoma patients treated with cerebral radiotherapy and anti-PD-1 antibodies.
Pires da Silva, Ines; Glitza, Isabella C; Haydu, Lauren E; Johnpulle, Romany; Banks, Patricia D; Grass, George D; Goldinger, Simone M A; Smith, Jessica L; Everett, Ashlyn S; Koelblinger, Peter; Roberts-Thomson, Rachel; Millward, Michael; Atkinson, Victoria G; Guminski, Alexander; Kapoor, Rony; Conry, Robert M; Carlino, Matteo S; Wang, Wei; Shackleton, Mark J; Eroglu, Zeynep; Lo, Serigne; Hong, Angela M; Long, Georgina V; Johnson, Douglas B; Menzies, Alexander M.
Afiliação
  • Pires da Silva I; Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
  • Glitza IC; The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Haydu LE; The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Johnpulle R; Vanderbilt University Medical Center, Nashville, Tennessee.
  • Banks PD; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • Grass GD; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
  • Goldinger SMA; University Hospital Zurich, Zurich, Switzerland.
  • Smith JL; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.
  • Everett AS; University of Alabama at Birmingham, Birmingham, Alabama.
  • Koelblinger P; Paracelsus Medical University, Salzburg, Austria.
  • Roberts-Thomson R; The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
  • Millward M; School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
  • Atkinson VG; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
  • Guminski A; Princess Alexandra Hospital and Greenslopes Private Hospital, University of Queensland, Brisbane, Queensland, Australia.
  • Kapoor R; Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
  • Conry RM; Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia.
  • Carlino MS; Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
  • Wang W; University of Alabama at Birmingham, Birmingham, Alabama.
  • Shackleton MJ; Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
  • Eroglu Z; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.
  • Lo S; Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
  • Hong AM; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.
  • Long GV; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • Johnson DB; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
  • Menzies AM; Department of Oncology, Alfred Health, Melbourne, Victoria, Australia.
Pigment Cell Melanoma Res ; 32(4): 553-563, 2019 07.
Article em En | MEDLINE | ID: mdl-30767428
ABSTRACT

BACKGROUND:

Brain radiotherapy is used in the management of melanoma brain metastases (MBM) and can result in radionecrosis. Anti-PD-1 is active in the brain and may increase the risk of radionecrosis when combined with radiotherapy. We studied the incidence, associated factors and management of radionecrosis in longer-term survivors with MBM treated with this combination.

METHODS:

Patients with MBM treated with radiotherapy and anti-PD-1 who survived >1 year were identified to determine radionecrosis incidence (Cohort A, n = 135). Cohort A plus additional radionecrosis cases were examined for factors associated with radionecrosis and management (Cohort B, n = 148).

RESULTS:

From Cohort A, 17% developed radionecrosis, with a cumulative incidence at 2 years of 18%. Using Cohort B, multivariable analysis confirmed an association between radionecrosis and elevated lactate dehydrogenase (p = 0.0496) and prior treatment with ipilimumab (p = 0.0319). Radionecrosis was diagnosed based on MRI (100%), symptoms (69%) and pathology (56%). Treatment included corticosteroids, bevacizumab and neurosurgery.

CONCLUSIONS:

Radionecrosis is a significant toxicity in longer-term melanoma survivors with MBM treated with anti-PD-1 and radiotherapy. Identification of those at risk of radionecrosis who may avoid radiotherapy is required.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Lesões por Radiação / Encéfalo / Receptor de Morte Celular Programada 1 / Melanoma / Anticorpos Idioma: En Ano de publicação: 2019 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Lesões por Radiação / Encéfalo / Receptor de Morte Celular Programada 1 / Melanoma / Anticorpos Idioma: En Ano de publicação: 2019 Tipo de documento: Article