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Benefit of ablative versus palliative-only radiotherapy in combination with nivolumab in patients affected by metastatic kidney and lung cancer

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Abstract

Purpose

Here, we present the results from a retrospective analysis, with the purpose of evaluating the safety and feasibility of nivolumab and radiotherapy (RT) concomitant association in metastatic kidney and lung cancer patients.

Materials and methods

From August 2015 until September 2017, we retrospectively observed 20 patients with metastatic lung and renal cell carcinoma who had been initiated therapy with nivolumab and underwent concomitant RT. RT was administered either as an ablative therapy in the oligometastatic/oligoprogressive setting or as palliative-only treatment for symptomatic patients. Data on progression-free and overall survival (PFS and OS), treatment response and adverse events were collected and reported. Comparison between palliative-only and ablative treatments was performed.

Results

PFS and OS were 7 and 12.5 months in the entire population, respectively. Oligoprogressive patients treated with ablative intent, compared to patients undergoing RT with palliative-only intent, had statistically longer PFS (11.5 vs 5.2 months, HR 0.42, CI 0.18–0.98, p 0.03) and OS (17.9 vs 10.31 months, HR 0.41 CI 0.16–1.02, p 0.04). Considering only patients treated with ablative intent, 87.5% showed response to treatment, and complete response was reported in 37.5% of cases. Adverse G2–G3 related to combination treatment were reported as follows: 1 gastrointestinal (nausea), 4 breakthrough pain.

Conclusions

Our data showed significant advantage for oligoprogressive patients treated with RT during nivolumab therapy. No safety alert emerged. These results underline the potential synergistic effects of RT and Immune therapy combination. Our analysis prompts further prospective studies exploring the benefit of integrated treatment strategies.

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Authors and Affiliations

  1. Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Viale Morgagni 85, 50134, Florence, Italy

    I. Desideri, G. Francolini, V. Scotti, D. Pezzulla, C. Becherini, F. Terziani, C. Delli Paoli, E. Olmetto, L. Visani, I. Meattini, D. Greto, P. Bonomo, M. Loi, B. Detti & L. Livi

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  1. I. Desideri
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  2. G. Francolini
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  3. V. Scotti
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  4. D. Pezzulla
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  5. C. Becherini
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  6. F. Terziani
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  7. C. Delli Paoli
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  9. L. Visani
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  13. M. Loi
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  14. B. Detti
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  15. L. Livi
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Correspondence to I. Desideri.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (“Comitato Etico Area Vasta Centro”) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Desideri, I., Francolini, G., Scotti, V. et al. Benefit of ablative versus palliative-only radiotherapy in combination with nivolumab in patients affected by metastatic kidney and lung cancer. Clin Transl Oncol 21, 933–938 (2019). https://doi.org/10.1007/s12094-018-02005-7

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  • DOI: https://doi.org/10.1007/s12094-018-02005-7

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