TY - JOUR
T1 - Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy
T2 - A systematic review
AU - Kroeze, Stephanie G C
AU - Fritz, Corinna
AU - Hoyer, Morten
AU - Lo, Simon S.
AU - Ricardi, Umberto
AU - Sahgal, Arjun
AU - Stahel, Rolf
AU - Stupp, Roger
AU - Guckenberger, Matthias
N1 - Publisher Copyright:
© 2016 The Author(s)
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
KW - Concurrent
KW - Immunotherapy
KW - Stereotactic radiotherapy
KW - Targeted therapy
KW - Toxicity
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U2 - 10.1016/j.ctrv.2016.11.013
DO - 10.1016/j.ctrv.2016.11.013
M3 - Review article
C2 - 28056412
AN - SCOPUS:85007575567
VL - 53
SP - 25
EP - 37
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
SN - 0305-7372
ER -