Safety checkpoint.

Top Line: Prospective data evaluating the safety of immune checkpoint inhibitors (ICI) concurrent with radiosurgery (SRS) remains lacking, probably because Big Pharma just isn't interested.

The Study: In the meantime, we’ll keep relying on our robust experiences to give us confidence. Here is a look back at outcomes among 50 patients receiving SRS for 395 brain mets from renal cell carcinoma (RCC). Roughly half (n=23) received ICI during or within 4 weeks of SRS while the rest (n=27) didn’t. The median dose to cover the planning target volume was 20 Gy in a single fraction, and the median volume of brain receiving over 12 Gy (V12Gy) was 8.4 cc (range: 0.3-111.2 cc). The primary endpoint of radiation necrosis occurred in 17% of those receiving ICI with 4 weeks of SRS and 22% otherwise. Perhaps more importantly, symptomatic radionecrosis occurred in 4% versus 15%, respectively. As expected, the biggest predictor of radionecrosis across the entire cohort was not receipt of ICI, or even V12Gy or prior whole brain irradiation, but target volume.

TBL: Supporting prior data across all histologies, it does not appear that receipt of ICI around the time of SRS for RCC brain mets increases risk of radionecrosis. | Lehrer, Cancer 2022



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