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

• Published in: Clinical & translational oncology Vol. 21; no. 7; pp. 933 - 938
• Main Authors: Desideri, I., Francolini, G., Scotti, V., Pezzulla, D., Becherini, C., Terziani, F., Delli Paoli, C., Olmetto, E., Visani, L., Meattini, I., Greto, D., Bonomo, P., Loi, M., Detti, B., Livi, L.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2019
• Subjects: Antineoplastic Agents, Immunological - therapeutic use; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - therapy; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - therapy; Chemoradiotherapy - mortality; Female; Follow-Up Studies; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Nivolumab - therapeutic use; Oncology; Palliative Care; Prognosis; Radiotherapy, Intensity-Modulated - mortality; Research Article; Retrospective Studies; Survival Rate; Metastatic kidney and lung cancer; Nivolumab; Immunotherapy; Stereotactic radiotherapy
• ISSN: 1699-048X; 1699-3055
• DOI: 10.1007/s12094-018-02005-7

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.