Improving Outcomes in RCC Brain Metastasis With SRS and Immunotherapy

Manmeet Ahluwalia, MD, MBA, FASCO, chief scientific officer, chief of medical oncology, deputy director, and Fernandez Family endowed chair in cancer research at the Baptist Health Miami Cancer Institute, discusses the takeaways from a study which examined the impact of various therapies, including combination treatments, for patients with metastatic renal cell carcinoma (RCC).

Stereotactic radiosurgery (SRS) improves outcomes in brain metastasis treatment. Within this research, investigators analyzed the National Cancer Database (2004-2020) for patients with brain metastasis from RCC, categorizing them by treatment type. This included either WBRT ± immunotherapy, SRS ± immunotherapy, and immunotherapy alone.

Findings presented at the 2024 ASCO Annual Meeting showed that combining SRS with immunotherapy significantly improves overall survival in RCC with brain metastasis.

Transcription:

0:09 | Traditionally, we treat patients with brain metastases either with radiation, which was given either as whole brain radiation or focused forms of radiation, what we call as stereotactic radiosurgery. What we found out from this large national database is that those patients who got radiosurgery and immunotherapy actually did the best. The overall survival in those patients with renal cell cancer and brain metastases was approximately 19 months, which paired better than 10 months or so that we saw either in those patients who received whole brain radiation or received immunotherapy alone, making radiosurgery in combination with immunotherapy a preferred way to treat these patients. This is also in alignment with what we have seen in other cancers, like lung cancer, where we are seeing the combination of immunotherapy and radiosurgery to be highly promising in patients with brain metastases.

1:04 | If we look at it mechanistically, combining radiosurgery with immunotherapy makes sense because when we give patients radiosurgery, it leads to a new epitope expression increase. So it almost is like we use radiation as a vaccine sensitizer or immunotherapy sensitizer. That can help us further boost the immunotherapies immune response. When we combine the 2, we are seeing better outcomes in these patients than with either immunotherapy alone or radiosurgery alone. This has also been seen in lung cancer, as well as melanoma brain metastases.