Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: A systematic review

Stephanie G C Kroeze, Corinna Fritz, Morten Hoyer, Simon S. Lo, Umberto Ricardi, Arjun Sahgal, Rolf Stahel, Roger Stupp, Matthias Guckenberger

Research output: Contribution to journalReview article

63 Scopus citations

Abstract

Background and purpose Both stereotactic radiotherapy (SRT) and immune- or targeted therapy play an increasingly important role in personalized treatment of metastatic disease. Concurrent application of both therapies is rapidly expanding in daily clinical practice. In this systematic review we summarize severe toxicity observed after concurrent treatment. Material and methods PubMed and EMBASE databases were searched for English literature published up to April 2016 using keywords “radiosurgery”, “local ablative therapy”, “gamma knife” and “stereotactic”, combined with “bevacizumab”, “cetuximab”, “crizotinib”, “erlotinib”, “gefitinib”, “ipilimumab”, “lapatinib”, “sorafenib”, “sunitinib”, “trastuzumab”, “vemurafenib”, “PLX4032”, “panitumumab”, “nivolumab”, “pembrolizumab”, “alectinib”, “ceritinib”, “dabrafenib”, “trametinib”, “BRAF”, “TKI”, “MEK”, “PD1”, “EGFR”, “CTLA-4” or “ALK”. Studies performing SRT during or within 30 days of targeted/immunotherapy, reporting severe (⩾Grade 3) toxicity were included. Results Concurrent treatment is mostly well tolerated in cranial SRT, but high rates of severe toxicity were observed for the combination with BRAF-inhibitors. The relatively scarce literature on extra-cranial SRT shows a potential risk of increased toxicity when SRT is combined with EGFR-targeting tyrosine kinase inhibitors and bevacizumab, which was not observed for cranial SRT. Conclusions This review gives a best-possible overview of current knowledge and its limitations and underlines the need for a timely generation of stronger evidence in this rapidly expanding field.

Original languageEnglish (US)
Pages (from-to)25-37
Number of pages13
JournalCancer Treatment Reviews
Volume53
DOIs
StatePublished - Feb 1 2017

    Fingerprint

Keywords

  • Concurrent
  • Immunotherapy
  • Stereotactic radiotherapy
  • Targeted therapy
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Kroeze, S. G. C., Fritz, C., Hoyer, M., Lo, S. S., Ricardi, U., Sahgal, A., Stahel, R., Stupp, R., & Guckenberger, M. (2017). Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: A systematic review. Cancer Treatment Reviews, 53, 25-37. https://doi.org/10.1016/j.ctrv.2016.11.013