A recent real world study has found that giving immunotherapy to previously untreated kidney cancer patients or stereotactic radiotherapy or surgery (focal therapy) improved overall survival time for patients with spread of their cancer to the brain (brain metastases).

In this real world study of 389 patients with brain metastases, overall survival time was nearly two years and nine months for patients who were treated with immunotherapy combinations, compared with nearly one year and eight months for patients treated with a tyrosine kinase inhibitor (TKI). For patients treated with stereotactic radiotherapy or surgery to remove metastases from the brain (neurosurgery), overall survival time was double that of patients who had whole brain radiotherapy alone or no focal therapy (31.4 compared to 16.5 months).

There was a 51% reduction in the risk of death with immunotherapy compared to TKI treatments. With stereotactic radiotherapy or neurosurgery there was a 52% lower risk of death compared with whole brain radiotherapy alone or no focal therapy.

The study included patients who were treated with the following immunotherapy combinations as a first treatment: nivolumab/ipilimumab, pembrolizumab/axitinib, avelumab/axitinib, nivolumab/cabozantinib, pembrolizumab/lenvatinib, or atezolizumab/bevacizumab or the following TKIs: sunitinib or pazopanib.

“This is a very important study and highlights that this patient population should be considered as the focus of future innovative clinical trials, and there definitely should not be an exclusion simply because they are not anticipated to have a favourable outcome,” said Dr Philippe E. Spiess, assistant chief of surgical services and high-volume kidney cancer surgeon at the Moffitt Cancer Center in Tampa, Florida. “Up until this point, these patients were never eligible for clinical trial participation, as it was thought they would do poorly, but now with promising outcomes with new treatment combinations along with site-directed brain radiation, our clinical approach to these patients needs to adapt to one offering more hope and personalisation.”

However, the study was limited by its retrospective design and absence of data on PD-L1 receptors or spread of the cancer within and outside the brain. The findings from this study are biased because the selection of patients was in favour of those who were suitable for stereotactic radiotherapy or neurosurgery, whereas those who were unable to receive these treatments due to the presence of more or larger tumours might have been steered toward whole brain radiotherapy.

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