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Type and timing of systemic therapy use predict overall survival for patients with brain metastases treated with radiation therapy

  • Clinical Study
  • Published:
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Abstract

Introduction

This study aimed to investigate whether systemic therapy (ST) use surrounding radiation therapy (RT) predicts overall survival (OS) after RT for patients with brain metastases (BMs).

Methods

Provincial RT and pharmacy databases were used to review all adult patients in British Columbia, Canada, who received a first course of RT for BMs between 2012 and 2016 (n = 3095). Multivariate analysis on a randomly selected subset was used to develop an OS nomogram.

Results

In comparison to the 2096 non-recipients of ST after RT, the median OS of the 999 recipients of ST after RT was 5.0 (95% Confidence interval (CI) 4.1–6.0) months longer (p < 0.0001). Some types of ST after RT were independently predictive of OS: targeted therapy (hazard ratio (HR) 0.42, CI 0.37–0.48), hormone therapy (HR 0.45, CI 0.36–0.55), cytotoxic chemotherapy (HR 0.71, CI 0.64–0.79), and immunotherapy (HR 0.64, CI 0.37–1.06). Patients who discontinued ST after RT had 0.9 (CI 0.3–1.4) months shorter median OS than patients who received no ST before or after RT (p < 0.0001). In the multivariate analysis of the 220-patient subset, established prognostic variables (extracranial disease, performance status, age, cancer diagnosis, and number of BMs), and the novel variables “ST before RT” and “Type of ST after RT” independently predicted OS. The nomogram predicted 6- and 12-month OS probability and median OS (bootstrap-corrected Harrell’s Concordance Index = 0.70).

Conclusions

The type and timing of ST use surrounding RT predict OS for patients with BMs.

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Authors and Affiliations

  1. University of British Columbia, Vancouver, BC, Canada

    Kevin Yijun Fan, Nafisha Lalani, Nathalie LeVasseur, Andra Krauze, Fred Hsu & Alan McVey Nichol

  2. BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada

    Nafisha Lalani, Nathalie LeVasseur, Andra Krauze, Fred Hsu, Lovedeep Gondara, Kaylie Willemsma & Alan McVey Nichol

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Contributions

Study conception and design: KF, LG and AN; Data acquisition: KF and KW; Analysis and interpretation of data: KF, NLa, NLe, AK, FH, LG and AN. All authors contributed to drafting the manuscript, approved the final version and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Alan McVey Nichol.

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Ethical approval

This study was approved by the University of British Columbia – BC Cancer Research Ethics Board (H19-02273).

Conflict of interest

Nathalie LeVasseur declares advisory roles for Pfizer, Novartis, Tersera, Roche, and Genomic health, and research funding from Genomic Health and Abbvie. Alan Nichol declares research funding from Varian Medical Systems Ltd. The other authors have no conflicts of interest to declare.

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Fan, K.Y., Lalani, N., LeVasseur, N. et al. Type and timing of systemic therapy use predict overall survival for patients with brain metastases treated with radiation therapy. J Neurooncol 151, 231–240 (2021). https://doi.org/10.1007/s11060-020-03657-8

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  • DOI: https://doi.org/10.1007/s11060-020-03657-8

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