Abstract
Background. Targeted therapies and Immune checkpoint inhibitors are currently modifying the landscape of metastatic cancer management, and are increasingly used over the course of many cancers treatment. They allow long-term survival with controlled extra-cerebral disease, contributing to the increasing incidence of brain metastases. Radiation therapy remains the cornerstone of brain metastases treatment (either whole brain irradiation or stereotactic radiosurgery), and investigating the safety profile of radiation therapy combined with targeted therapies or immune checkpoint inhibitors is of high interest. Discontinuing an efficient systemic therapy, when brain metastases irradiation is considered, might allow systemic disease progression and, on the other hand, the mechanisms of action of these two therapeutic modalities might lead to unexpected toxicities and/or greater efficacy, when combined.Patients and methods. We performed a systematic literature review focusing on the safety profile and the efficacy of brain metastases radiation therapy combined with targeted agents or immune checkpoint inhibitors, emphasizing on the role (if any) of the sequence of combination scheme (drug given before, during, and/or after radiation therapy).Results. Whereas no relevant toxicity has been noticed with most of these drugs, the concomitant use of some other drugs with brain irradiation requires caution.Conclusion. Most of available studies appear to advocate for targeted therapies or immune checkpoint inhibitors combination with radiation therapy, without altering the clinical safety profiles, allowing the maintenance of systemic treatments when stereotactic radiation therapy is considered. Cognitive functions, health-related quality of life and radiation necrosis risk remain to be assessed. The results of prospective studies are awaited in order to complete and validate the above discussed retrospective data.http://ift.tt/2vnG3dF
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου