Evidence map›Paper›PMID 32747372›Full record

ArticleESMO open2020

Response assessment and outcome of combining immunotherapy and radiosurgery for brain metastasis from malignant melanoma.

Emilie Le Rhun, Fabian Wolpert, Maud Fialek, Patrick Devos, Nicolaus Andratschke, Nicolas Reyns, Luca Regli, Reinhard Dummer, Laurent Mortier, Michael Weller

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in ESMO open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 3 pooled it
2.3field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 25 citations in OpenAlex.

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  13. [Ongoing Evaluation of Immune-related Response Assessment in Brain Metastases].Zhongguo fei ai za zhi = Chinese journal of lung cancer · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Emilie Le RhunUniversity of Lille, Inserm, Lille, France.ORCID 0000-0002-9408-3278
Fabian WolpertDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Maud FialekCHU lille, Service de Dermatologie, Lille, France.
Patrick DevosUniv. Lille, CHU Lille, METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France.
Nicolaus AndratschkeDepartment of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland.
Nicolas ReynsCHU Lille, General and Stereotaxic Neurosurgery service, Lille, France.
Luca RegliDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Reinhard DummerDepartment of Dermatology, University Hospital and University of Zurich, Zurich, Switzerland.ORCID 0000-0002-2279-6906
Laurent MortierUniversity of Lille, Inserm, CHU Lille, Service de Dermatologie, Lille, France.
Michael WellerDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland Michael.Weller@usz.ch.
University of Zurich · CHInserm · FRUniversité de Lille · FRCentre Hospitalier Universitaire de Lille · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe optimal sequence of stereotactic radiotherapy (SRT) and immune checkpoint inhibition (ICI) and assessment of response in patients with brain metastases from melanoma remain challenging.

methodsWe reviewed clinical and neuroimaging data of 62 patients with melanoma, including 26 patients with BRAF-mutant tumours, with newly diagnosed brain metastases treated with ICI alone (n=10, group 1), SRT alone or in combination with other systemic therapies (n=20, group 2) or ICI plus SRT (n=32, group 3). Response was assessed retrospectively using response evaluation criteria in solid tumours (RECIST) V.1.1, response assessment in neuro-oncology (RANO) and immunotherapy RANO (iRANO) criteria. MRI follow-up from 43 patients was available for central review.

resultsPatients treated with ICI alone showed no objective responses and had worse outcome than patients treated with SRT without or with ICI. RECIST, RANO and iRANO criteria were concordant for complete response (CR) and partial response (PR). RANO called progression earlier than RECIST for clinical deterioration without MRI progression in some patients. Progression was called later when using iRANO criteria because of the need for a confirmatory scan. Pseudoprogression was documented in seven patients: three patients in group 2 and four patients in group 3. Radionecrosis was documented in seven patients: two patients in group 2 and five patients in group 3. Regression of non-irradiated lesions was seen neither in two patients treated with SRT alone nor in five patients treated with SRT plus ICI, providing no evidence for rare abscopal effects.

conclusionsPseudoprogression is uncommon with ICI alone, suggesting that growing lesions in such patients should trigger an intervention. Pseudoprogression rates were similar after SRT alone or SRT in combination with ICI. Abscopal effects are rare or do not exist. Response assessment criteria should be considered carefully when designing clinical studies for patients with brain metastases who receive SRT.

Indexed as

Brain NeoplasmsImmunotherapyMelanomaRadiosurgeryAgedHumansMiddle AgedRetrospective Studiescriteriagamma knifepseudoprogressionradionecrosisstereotactic radiotherapy

Identifiers

PMID32747372
PMCPMC7401999
OpenAlexW3047507854

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.