Possible Interaction of Anti–PD-1 Therapy with the Effects of Radiosurgery on Brain Metastases

Cancer Immunology Research - Tập 4 Số 6 - Trang 481-487 - 2016
Ahmed Al‐Omari1, Justine V. Cohen2, Alexander O. Vortmeyer1, Anne C. Chiang2, Scott Gettinger2, Sarah B. Goldberg2, Harriet M. Kluger2, Veronica Chiang3
11Department of Pathology, Yale University, School of Medicine, New Haven, Connecticut.
22Department of Medicine (Medical Oncology), Yale University, School of Medicine, New Haven, Connecticut.
33Department of Neurosurgery, Yale University, School of Medicine, New Haven, Connecticut.

Tóm tắt

Abstract Delayed radiation-induced vasculitic leukoencephalopathy related to stereotactic radiosurgery (SRS) of brain metastases has been reported to manifest clinically 9 to 18 months after treatment. Immune-modulating therapies have been introduced to treatment regimens for malignancies with metastatic predilection to the brain. The interaction of these systemic therapies with other modalities of treatment for brain metastases, namely, SRS, has not been fully characterized. We report two patients with metastatic malignancies to the brain who received SRS followed by immunotherapy with monoclonal antibodies (mAb) to programmed death 1 (PD-1). Both patients appeared to have early clinical and radiologic progression of their treated lesions, which was highly suspicious for tumor progression. Both patients underwent surgical resection of their lesions and the material was submitted for histopathologic examination. Pathologic examination in both cases showed predominantly radiation-induced changes characterized by reactive astrocytosis and vascular wall infiltration by T lymphocytes. The accelerated response to SRS in these two patients was temporally related to the initiation of immunotherapy. We propose a possible biologic interaction between SRS and the PD-1 mAbs. Additionally, awareness of this potential occurrence is critical for accurate interpretation and proper management of clinical and radiologic findings in these patients. Cancer Immunol Res; 4(6); 481–7. ©2016 AACR.

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Cancer Immunology Research

Tập 4 Số 6

481-487

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