Duke Researchers Find Offering Dual ICPI to Some Patients Receiving SRS for Brain Metastases Significantly Improves Local and Intracranial Control

Duke researchers have found that offering dual immune-checkpoint inhibition (ICPI) to patients with melanoma or non-small cell lung cancer who are receiving stereotactic radiosurgery (SRS) for brain metastases significantly improves local and intracranial control.

The study, published in International Journal of Radiation Oncology, Biology, Physics, comes from  Duke Center for Brain and Spine Metastasis researchers, including senior author Zach Reitman, MD, PhD, and first author Eugene Vaios, MD.

Notably, 57% of patients receiving dual ICPI in this study had symptomatic intracranial disease. Additionally, the improved outcomes with the addition of dual ICPI were independent of fractionation, tumor histology, or whether immunotherapy was delivered concurrently or sequentially with SRS. Sequential treatment was defined as immunotherapy delivered more than 30 days before or after SRS.  

“This is the largest single-institution series to report outcomes with SRS and immunotherapy and the first to evaluate long-term outcomes with dual ICPI,” Vaios said. “These results agree with the ABC and CheckMate-204 trials, as well as a recent post-hoc analysis of the CheckMate-9LA trial, which demonstrated improved intracranial efficacy with dual ICPI. Dual ICPI plus SRS appears to be an effective treatment option for NSCLC and melanoma brain metastasis patients, including those with symptomatic disease and larger intracranial disease burden.”