Top Line: How do we safely integrate SBRT into targeted therapy or immunotherapy regimens for oligometastatic cancer?
The Study: Over the past few years, SBRT and consolidative radiation has been increasingly used to treat oligometastatic cancer. The radiation approach to treating oligometastatic disease has become much more refined, but at the same time there is an ever-expanding list of systemic agents that might affect the safety of SBRT. It is challenging to know which drugs are safe with SBRT in certain anatomic sites and when should they be held during treatment. Here is a helpful systematic review and expert consensus recommendation from a panel of 28 experts (26 rad onc and 2 med onc) from ESTRO and the EORTC. The authors reviewed a long list of immunotherapy and targeted drugs to assess the risk of toxicity when administered around the time of SBRT. They focused on three questions: 1) can the drug and SBRT be administered on the same day, 2) should the standard systemic therapy regimen be interrupted for SBRT, and 3) what minimum time interval should there be between the most recent cycle and the start of SBRT? The list of drugs reviewed by this study is pretty exhaustive, and the figures make good references for the variety of expert approaches to systemic therapy with SBRT. A few of the highlights were that most immune checkpoint inhibitors have low risk of toxicity and can be continued uninterrupted (although not administered the same day as SBRT). An exception was ipilimumab and especially combined immune checkpoint inhibition where there was near-consensus to wait at least 1 week between systemic therapy and SBRT and some experts considered interrupting therapy. There was also consensus to interrupt at least 1 cycle of VEGF inhibition and wait at least 1 week before SBRT due to an increased risk of toxicity particularly in the abdomen.
TBL: These expert recommendations provide a useful framework for safely integrating SBRT for oligometastatic cancer in patients receiving immunotherapy and targeted systemic therapies. | Kroeze, Lancet Oncol 2023
The Study: Over the past few years, SBRT and consolidative radiation has been increasingly used to treat oligometastatic cancer. The radiation approach to treating oligometastatic disease has become much more refined, but at the same time there is an ever-expanding list of systemic agents that might affect the safety of SBRT. It is challenging to know which drugs are safe with SBRT in certain anatomic sites and when should they be held during treatment. Here is a helpful systematic review and expert consensus recommendation from a panel of 28 experts (26 rad onc and 2 med onc) from ESTRO and the EORTC. The authors reviewed a long list of immunotherapy and targeted drugs to assess the risk of toxicity when administered around the time of SBRT. They focused on three questions: 1) can the drug and SBRT be administered on the same day, 2) should the standard systemic therapy regimen be interrupted for SBRT, and 3) what minimum time interval should there be between the most recent cycle and the start of SBRT? The list of drugs reviewed by this study is pretty exhaustive, and the figures make good references for the variety of expert approaches to systemic therapy with SBRT. A few of the highlights were that most immune checkpoint inhibitors have low risk of toxicity and can be continued uninterrupted (although not administered the same day as SBRT). An exception was ipilimumab and especially combined immune checkpoint inhibition where there was near-consensus to wait at least 1 week between systemic therapy and SBRT and some experts considered interrupting therapy. There was also consensus to interrupt at least 1 cycle of VEGF inhibition and wait at least 1 week before SBRT due to an increased risk of toxicity particularly in the abdomen.
TBL: These expert recommendations provide a useful framework for safely integrating SBRT for oligometastatic cancer in patients receiving immunotherapy and targeted systemic therapies. | Kroeze, Lancet Oncol 2023