PMID- 30202807
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220321
IS  - 2452-1094 (Print)
IS  - 2452-1094 (Electronic)
IS  - 2452-1094 (Linking)
VI  - 3
IP  - 3
DP  - 2018 Jul-Sep
TI  - Safety of combining thoracic radiation therapy with concurrent versus sequential 
      immune checkpoint inhibition.
PG  - 391-398
LID - 10.1016/j.adro.2018.05.001 [doi]
AB  - 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.
FAU - von Reibnitz, Donata
AU  - von Reibnitz D
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Chaft, Jamie E
AU  - Chaft JE
AD  - Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, 
      New York.
FAU - Wu, Abraham J
AU  - Wu AJ
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Samstein, Robert
AU  - Samstein R
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Hellmann, Matthew D
AU  - Hellmann MD
AD  - Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, 
      New York.
FAU - Plodkowski, Andrew J
AU  - Plodkowski AJ
AD  - Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New 
      York.
FAU - Zhang, Zhigang
AU  - Zhang Z
AD  - Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 
      New York.
FAU - Shi, Weiji
AU  - Shi W
AD  - Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 
      New York.
FAU - Dick-Godfrey, Rosalind
AU  - Dick-Godfrey R
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Panchoo, Kelly H
AU  - Panchoo KH
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Barker, Christopher A
AU  - Barker CA
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
FAU - Rimner, Andreas
AU  - Rimner A
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New 
      York, New York.
LA  - eng
GR  - P30 CA008748/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20180509
PL  - United States
TA  - Adv Radiat Oncol
JT  - Advances in radiation oncology
JID - 101677247
PMC - PMC6128092
EDAT- 2018/09/12 06:00
MHDA- 2018/09/12 06:01
PMCR- 2018/05/09
CRDT- 2018/09/12 06:00
PHST- 2017/10/06 00:00 [received]
PHST- 2018/04/23 00:00 [revised]
PHST- 2018/05/03 00:00 [accepted]
PHST- 2018/09/12 06:00 [entrez]
PHST- 2018/09/12 06:00 [pubmed]
PHST- 2018/09/12 06:01 [medline]
PHST- 2018/05/09 00:00 [pmc-release]
AID - S2452-1094(18)30079-4 [pii]
AID - 10.1016/j.adro.2018.05.001 [doi]
PST - epublish
SO  - Adv Radiat Oncol. 2018 May 9;3(3):391-398. doi: 10.1016/j.adro.2018.05.001. 
      eCollection 2018 Jul-Sep.