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Utility of molecular markers in predicting local control specific to lung cancer spine metastases treated with stereotactic body radiotherapy

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Abstract

Background and purpose

We report outcomes following spine stereotactic body radiotherapy (SBRT) in metastatic non-small cell lung cancer (NSCLC) and the significance of programmed death-ligand 1 (PD-L1) status, epidermal growth factor receptor (EGFR) mutation and timing of immune check point inhibitors (ICI) on local failure (LF).

Materials and methods

165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary, overall survival (OS) and vertebral compression fracture (VCF). Multivariable analysis (MVA) evaluated factors predictive of LF and VCF.

Results

The median follow-up and OS were: 13.0 months (range, 0.5–95.3 months) and 18.4 months (95% CI 11.4–24.6). 52.1% were male and 76.4% had adenocarcinoma. Of the 389 segments, 30.3% harboured an EGFR mutation and 17.0% were PD-L1 ≥ 50%. The 24 months LF rate in PD-L1 ≥ 50% vs PD-L1 < 50% was 10.7% vs. 38.0%, and in EGFR-positive vs. negative was 18.1% vs. 30.0%. On MVA, PD-L1 status of ≥ 50% (HR 0.32, 95% CI 0.15–0.69, p = 0.004) significantly predicted for lower LF compared to PD-L1 < 50%. Lower LF trend was seen with ICI administration peri and post SBRT (HR 0.41, 95% CI 0.16–1.05, p = 0.062). On MVA, polymetastatic disease (HR 3.28, 95% CI 1.84–5.85, p < 0.0001) and ECOG ≥ 2 (HR 1.87, 95% CI 1.16–3.02, p = 0.011) significantly predicted for worse OS and absence of baseline VCF predicted for lower VCF rate (HR 0.20, 95% CI 0.10–0.39, p < 0.0001).

Conclusion

We report a significant association of PD-L1 ≥ 50% status on improved LC rates from spine SBRT in NSCLC patients.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

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Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    Dana Shor, Alexander V. Louie, Ines B. Menjak,  Chia-Lin Tseng, Jay Detsky, Beibei Zhang, Hany Soliman, Sten Myrehaug, Arjun Sahgal & Hanbo Chen

  2. Department of Radiation Oncology, Simcoe Muskoka Regional Cancer Centre, Barrie, ON, Canada

    Kang Liang Zeng

  3. Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada

    Eshetu G. Atenafu

  4. Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Jeremie Larouche

  5. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Pejman Maralani

  6. Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    David M. Hwang

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  1. Dana Shor
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Contributions

Dana Shor: Conceptualization, Investigation, writing original draft, writing-review and editing, visualization Alexander V. Louie: Conceptualization, methodology, validation, writing-review and editing, supervision K. Liang Zeng: Conceptualization, methodology, validation, writing-review and editing, supervision Ines Menjak: Conceptualization, methodology, validation, writing-review and editing Eshetu G. Atenafu: Formal analysis Chia-Lin Tseng: writing-review and editing Jay Detsky: writing-review and editing Jeremie Larouche: writing-review and editing Beibei Zhang: writing-review and editing Hany Soliman: writing-review and editing Sten Myrehaug: writing-review and editing Pejman Jabehdar Maralani: writing-review and editing David M. Hwang: writing-review and editing Arjun Sahgal: Conceptualization, methodology, validation, writing-review and editing, supervision Hanbo Chen: Conceptualization, methodology, validation, writing-review and editing, supervision.

Corresponding author

Correspondence to Hanbo Chen.

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Competing interests

The authors declare no competing interests.

Conflict of Interest/Disclosures for all authors

Dana Shor: None.

Alexander V. Louie: received honoraria from AstraZeneca for speakers bureau and advisory board participation unrelated to this work.

K. Liang Zeng: None.

Ines Menjak: received honoraria from AstraZeneca and Merck for presentations this year, education funding from AstraZeneca.

Eshetu G. Atenafu: None.

Chia-Lin Tseng: has received travel accommodations/expenses and honoraria for past educational seminars from Elekta and Abbvie, belongs to the Elekta MR-Linac Research Consortium and Lead for the Brain Tumor Site Group, and is an advisor/consultant with Sanofi.

Jay Detsky: None.

Jeremie Larouche: None.

Beibei Zhang: None.

Hany Soliman: None.

Sten Myrehaug: None.

Pejman Jabehdar Maralani: None.

David M. Hwang: received research grants with AstraZeneca, Pfizer, EMD-Serono; has consulted for Novartis, Merck, Amgen, Bayer, Bristol-Myers-Squibb, AstraZeneca, Roche, Eli Lilly, GlaxoSmithKline (GSK); has received honoraria for past educational seminars from Merck, Novartis, AstraZeneca, Pfizer.

Arjun Sahgal: received research grants with Elekta AB, Varian, Seagen Inc, BrainLAB; has consulted for Elekta, and BrainLAB; has received honoraria for past educational seminars from AstraZeneca, Elekta, Varian, BrainLAB, Seagen Inc.; is a Vice President of the International Stereotactic Radiosurgery Society (ISRS); is the past co-chair of the AO Spine Knowledge Forum Tumor; belongs to the Elekta MR-Linac Research Consortium.

Hanbo Chen: None.

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Shor, D., Louie, A.V., Zeng, K.L. et al. Utility of molecular markers in predicting local control specific to lung cancer spine metastases treated with stereotactic body radiotherapy. J Neurooncol 167, 275–283 (2024). https://doi.org/10.1007/s11060-024-04603-8

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