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Safety of combining thoracic radiation therapy with concurrent versus sequential immune checkpoint inhibition
- Source :
- Advances in Radiation Oncology, Vol 3, Iss 3, Pp 391-398 (2018), Advances in Radiation Oncology
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Purpose The objective of this study was to evaluate adverse events (AEs) in patients who received both immune checkpoint inhibitors and thoracic radiation therapy (RT). In particular, we compared the rate of toxicities of concurrent versus sequential delivery of thoracic RT and checkpoint inhibitors. Methods and Materials Patient and treatment characteristics were collected on all patients at our institution who were treated with programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and/or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors and underwent thoracic RT (n = 79). Receiving both treatments within 1 month was considered concurrent (n = 35; 44%), and any treatment up to 6 months apart was considered sequential (n = 44; 56%). The primary endpoint of this study was the rate of Grade ≥2 AEs from combination therapy (immunotherapy and RT), specifically those that are relevant to thoracic RT: Pneumonitis, other pulmonary events, esophagitis, dermatitis, and fatigue. Further univariate analysis was performed to compare AE rates with clinical and therapy-related variables. Results A total of 79 patients were identified, with lung cancer (n = 45) and melanoma (n = 15) being the most common primary histology. Sixty-two (78%) patients were treated with anti-PD-1 or anti-PD-L1 antibodies, 12 (15%) with anti-CTLA-4 antibodies, and 5 (6%) received both anti-PD-1/PD-L1 and anti-CTLA-4 antibodies. The median follow-up for survivors was 5.9 months (range, 2.4-55.6 months). Grade ≥2 AEs included pneumonitis (n = 5; 6%), esophagitis (n = 6; 8%), and dermatitis (n = 8; 10%). No statistically significant correlation was found between these AEs when comparing concurrent versus sequential treatment. The only significant variable was a correlation of immunotherapy drug category with Grade ≥2 esophagitis (P = .04). Conclusions Overall, Grade ≥2 AE rates of thoracic RT and immunotherapy appeared as expected and acceptable. The lack of significant differences in AE rates with concurrent versus sequential treatment suggests that even concurrent immunotherapy and thoracic RT may be safe.
- Subjects :
- lcsh:Medical physics. Medical radiology. Nuclear medicine
0301 basic medicine
medicine.medical_specialty
Combination therapy
lcsh:R895-920
medicine.medical_treatment
Thoracic Cancer
lcsh:RC254-282
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Internal medicine
Clinical endpoint
Medicine
Radiology, Nuclear Medicine and imaging
Adverse effect
Lung cancer
Pneumonitis
Univariate analysis
business.industry
Immunotherapy
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
3. Good health
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
business
Esophagitis
Subjects
Details
- ISSN :
- 24521094
- Volume :
- 3
- Database :
- OpenAIRE
- Journal :
- Advances in Radiation Oncology
- Accession number :
- edsair.doi.dedup.....14e71d0ab118dea45cc1bca42dd8055a