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Combination of stereotactic radiotherapy and targeted therapy: patterns-of-care survey in German-speaking countries

Kombination von stereotaktischer Strahlentherapie und zielgerichteter Therapie: Patterns-of-Care-Umfrage im deutschsprachigen Raum

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Abstract

Introduction

Stereotactic body radiotherapy (SBRT) is increasingly used in metastasized patients receiving targeted/immunotherapy. Information on safety and effectivity of concurrent SBRT and targeted/immunotherapy remains limited, resulting in a lack of consensus on treatment strategies. This study aimed to investigate how SBRT-experienced centers in German-speaking countries combine both therapies.

Materials and methods

Patterns-of-care of combined treatment with SBRT and targeted/immunotherapy were assessed in 27 radiation oncology centers (19 German, 1 Austrian and 7 Swiss centers). A survey was performed to analyze the details of SBRT, SBRT planning and combined modality treatment. Consensus was defined as ≥75% agreement among participants.

Results

Most participants (60%) were university centers. SBRT for oligometastases has been performed since the year 2008 (median, range 1997–2016), since then a median of 140 cases (5–1100) of SBRT have been performed. In all, 67% performed concurrent SBRT and targeted agents. BRAF inhibitors and VEGF/EGFR inhibitors (bevacizumab [90%], erlotinib [11%], sorafenib [19%], lapatinib [4%]) were considered a contraindication. Bevacizumab was never given simultaneously with SBRT; other agents were given concurrently in 7–52% of centers. A majority (59%) paused targeted agents 1 week before/after SBRT. Only 1 center reduced SBRT dose when combined with targeted agents.

Conclusion

Although evidence for safety and efficacy of concurrent SBRT and targeted agents is limited, it is regularly performed outside of clinical trials. The survey showed consensus not to combine SBRT with antiangiogenic agents, especially bevacizumab. Furthermore, SBRT with concurrent BRAF inhibitors should be practiced with caution and BRAF inhibitors should be paused at least 1 week before SBRT.

Zusammenfassung

Einleitung

Bei Metastasierung erhalten Patienten neben zielgerichteten („targeted therapy“, TT) oder Immuntherapien auch zunehmend Lokaltherapien, wie etwa die SBRT („stereotactic body radiotherapy“). Bisher gibt es nur wenig Informationen zu Wirksamkeit bzw. Sicherheit und daher keinen Konsens bezüglich der Therapiestrategien. Ziel dieser Studie war es, die Behandlungskonzepte erfahrener SBRT-Zentren in deutschsprachigen Ländern zu analysieren.

Methoden

Die Konzepte die Kombination einer SBRT mit einer TT/Immuntherapie wurden in 27 radioonkologischen Zentren in Deutschland (19), Österreich (1) und der Schweiz (7) erfasst. Die Umfrage beinhaltete Details zur durchgeführten SBRT, zur SBRT-Planung zu den kombinierten Therapiemodalitäten. Ein Behandlungskonsens war definiert als ≥75 % Übereinstimmung der an der Umfrage Teilnehmenden.

Ergebnisse

Die Mehrheit der teilnehmenden Zentren (60 %) waren Universitätskliniken. SBRT für Oligometastasen wurde im Median seit 2008 angewandt (1997–2016), im Median wurden seitdem 140 (5–1100) SBRTs durchgeführt. In der klinischen Routine führten 67 % der Zentren gleichzeitig eine SBRT und eine TT durch. BRAF-Inhibitoren (41 %) und Anti-VEGF/EGFR-Medikamente (Bevacizumab [90 %], Erlotinib [11 %], Sorafenib [19 %], Lapatinib [4 %]) wurden als Kontraindikation für eine zeitgleiche Therapie angesehen. Bevacizumab wurde von keinem Zentrum simultan verabreicht, andere zielgerichtete Therapien wurden gleichzeitig mit einer SBRT in 7–52 % der Zentren verabreicht. Die Mehrheit der Zentren (59 %) pausierte die TT eine Woche vor/nach der SBRT. Nur ein Zentrum reduzierte die SBRT-Dosis aufgrund einer kombinierten TT.

Schlussfolgerung

Obwohl nur eine limitierte Evidenz für die Sicherheit und Wirksamkeit einer kombinierten SBRT und TT existiert, wird diese Kombination regelmäßig außerhalb von klinischen Studien angewandt. In unserer Analyse zeigte sich ein Konsens, antiangiogenetische Wirkstoffe (Bevacizumab) nicht mit einer SBRT zu kombinieren. Eine BRAF-Inhibitor-Therapie sollte zumindest eine Woche vor/nach SBRT pausiert werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland

    S. G. C. Kroeze, C. Fritz, L. Basler & M. Guckenberger

  2. Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    E. Gkika & A. L. Grosu

  3. German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany

    E. Gkika & A. L. Grosu

  4. German Cancer Research Center (DKFZ), Heidelberg, Germany

    E. Gkika & A. L. Grosu

  5. Department of Radiation Oncology, University Hospital Magdeburg, Magdeburg, Germany

    T. B. Brunner

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  1. S. G. C. Kroeze
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  2. C. Fritz
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  3. L. Basler
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  4. E. Gkika
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  6. A. L. Grosu
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  7. M. Guckenberger
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Correspondence to S. G. C. Kroeze.

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Conflict of interest

S.G.C. Kroeze, C. Fritz, L. Basler, E. Gkika, T.B. Brunner, A.L. Grosu and M. Guckenberger declare that they have no competing interests.

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Kroeze, S.G.C., Fritz, C., Basler, L. et al. Combination of stereotactic radiotherapy and targeted therapy: patterns-of-care survey in German-speaking countries. Strahlenther Onkol 195, 199–206 (2019). https://doi.org/10.1007/s00066-018-01422-5

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  • DOI: https://doi.org/10.1007/s00066-018-01422-5

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