2024
Patterns of brain metastases response to immunotherapy with pembrolizumab
Mahajan A, Goldberg S, Weiss S, Tran T, Singh K, Joshi K, Aboian M, Kluger H, Chiang V. Patterns of brain metastases response to immunotherapy with pembrolizumab. Journal Of Neuro-Oncology 2024, 169: 555-561. PMID: 38963658, DOI: 10.1007/s11060-024-04754-8.Peer-Reviewed Original ResearchNon-small cell lung cancerBrain metastasesComplete resolutionLung cancerMedian time to CNS progressionLesion progressionNon-small cell lung cancer patientsModified RECIST criteriaPD-1 inhibitorsTrial of pembrolizumabEffective systemic treatmentResponse to immunotherapyPhase II trialCell lung cancerMethodsThis retrospective studyLocal treatment decisionsPurposeCentral nervous systemCNS progressionRECIST criteriaPD-1Local therapySystemic treatmentMRI evaluationResponse assessmentRetrospective studyExecutive summary of the American Radium Society appropriate use criteria for brain metastases in epidermal growth factor receptor mutated-mutated and ALK-fusion non-small cell lung cancer
Nagpal S, Milano M, Chiang V, Soltys S, Brackett A, Halasz L, Garg A, Sahgal A, Ahluwalia M, Tom M, Palmer J, Knisely J, Chao S, Gephart M, Wang T, Lo S, Chang E. Executive summary of the American Radium Society appropriate use criteria for brain metastases in epidermal growth factor receptor mutated-mutated and ALK-fusion non-small cell lung cancer. Neuro-Oncology 2024, 26: 1195-1212. PMID: 38459978, PMCID: PMC11226873, DOI: 10.1093/neuonc/noae041.Peer-Reviewed Original ResearchNon-small cell lung cancerTyrosine kinase inhibitorsCell lung cancerCentral nervous systemAmerican Radium SocietyALK-fusionBrain metastasesAmerican Radium Society Appropriate Use CriteriaLung cancerSequence of tyrosine kinase inhibitorsALK tyrosine kinase inhibitorsTreatment of brain metastasesEGFR tyrosine kinase inhibitorsWhole-brain RTEpidermal growth factor receptorGrowth factor receptorAppropriate Use CriteriaBrain RTEGFR-mutantRadiotherapyTreatment optionsFactor receptorKinase inhibitorsNervous systemLiterature search
2023
Management of patients with brain metastases from NSCLC without a genetic driver alteration: upfront radiotherapy or immunotherapy?
Merkin R, Chiang V, Goldberg S. Management of patients with brain metastases from NSCLC without a genetic driver alteration: upfront radiotherapy or immunotherapy? Therapeutic Advances In Medical Oncology 2023, 15: 17588359231175438. PMID: 37275964, PMCID: PMC10233588, DOI: 10.1177/17588359231175438.Peer-Reviewed Original ResearchImmune checkpoint inhibitorsBrain metastasesTargetable genetic alterationsLocal therapyLung cancerStereotactic radiosurgeryDeath 1 ligand 1 expressionManagement of BMSole metastatic siteStage IV diseaseWhole brain radiotherapyLigand 1 expressionPD-L1 expressionProspective clinical trialsTime of diagnosisManagement of patientsCell lung cancerCancer-related deathGenetic alterationsCentral nervous systemGenetic driver alterationsAnaplastic lymphoma kinaseEpidermal growth factor receptorGrowth factor receptorUpfront radiotherapy
2022
Multicenter analysis of stereotactic radiosurgery for multiple brain metastases from EGFR and ALK driven non-small cell lung cancer
Wandrey N, Gao D, Robin T, Contessa J, Singh C, Chiang V, Li J, Chen A, Wang Y, Sheehan J, Dutta S, Weiss S, Paly J, Rusthoven C. Multicenter analysis of stereotactic radiosurgery for multiple brain metastases from EGFR and ALK driven non-small cell lung cancer. Lung Cancer 2022, 176: 144-148. PMID: 36641932, PMCID: PMC10552603, DOI: 10.1016/j.lungcan.2022.11.019.Peer-Reviewed Original ResearchConceptsNon-small cell lung cancerOverall survivalCell lung cancerStereotactic radiosurgeryBrain metastasesMultivariable adjustmentMulticenter analysisLung cancerNext-generation tyrosine kinase inhibitorsSRS treatmentOnly negative prognostic factorWhole brain radiotherapyMedian overall survivalMultiple brain metastasesNegative prognostic factorFavorable overall survivalTyrosine kinase inhibitorsTreatment 1CNS progressionMulticenter outcomesMedian followPrognostic factorsFavorable prognosisCNS diseaseTreatment optionsBrain metastatic outgrowth and osimertinib resistance are potentiated by RhoA in EGFR-mutant lung cancer
Adua S, Arnal-Estapé A, Zhao M, Qi B, Liu Z, Kravitz C, Hulme H, Strittmatter N, López-Giráldez F, Chande S, Albert A, Melnick M, Hu B, Politi K, Chiang V, Colclough N, Goodwin R, Cross D, Smith P, Nguyen D. Brain metastatic outgrowth and osimertinib resistance are potentiated by RhoA in EGFR-mutant lung cancer. Nature Communications 2022, 13: 7690. PMID: 36509758, PMCID: PMC9744876, DOI: 10.1038/s41467-022-34889-z.Peer-Reviewed Original ResearchConceptsGene expression programsRas homolog family member ACancer cellsFamily member AEpidermal growth factor receptorExpression programsMetastatic cancer cellsSRF signalingGrowth factor receptorTumor microenvironmentLung cancerFunctional linkExtracellular lamininDrug-resistant cancer cellsMutant non-small cell lung cancerNon-small cell lung cancerCentral nervous system relapseMolecular studiesMember AEGFR-mutant lung cancerFactor receptorNervous system relapseCell lung cancerDisseminated tumor cellsBrain tumor microenvironmentNIMG-04. LONGITUDINAL TRACKING OF PERITUMORAL EDEMA VOLUME USING PACS-INTEGRATED TOOLS PROVIDES CRITICAL INFORMATION IN TREATMENT ASSESSMENT OF NSCLC BRAIN METASTASES AFTER RADIOSURGERY
Kaur M, Petersen G, von Reppert M, Jekel L, de Santo I, Varghese S, Chiang V, Aboian M. NIMG-04. LONGITUDINAL TRACKING OF PERITUMORAL EDEMA VOLUME USING PACS-INTEGRATED TOOLS PROVIDES CRITICAL INFORMATION IN TREATMENT ASSESSMENT OF NSCLC BRAIN METASTASES AFTER RADIOSURGERY. Neuro-Oncology 2022, 24: vii162-vii162. PMCID: PMC9661156, DOI: 10.1093/neuonc/noac209.624.Peer-Reviewed Original ResearchNSCLC brain metastasesPeritumoral edema volumeBrain metastasesEdema volumeLongest diameterGamma KnifeClinical practiceCE lesionsCommon intracranial malignancyStandard of careFLAIR hyperintense regionVolumetric measurementsIntracranial malignanciesEdema/Lung cancerTreatment responsePeritumoral volumesClinical informationPeritumoral edemaLongitudinal assessmentTreatment assessmentNeuroradiology practiceHyperintense regionsMetastasisLesionsHistological changes associated with laser interstitial thermal therapy for radiation necrosis: illustrative cases
Fomchenko EI, Leelatian N, Darbinyan A, Huttner AJ, Chiang VL. Histological changes associated with laser interstitial thermal therapy for radiation necrosis: illustrative cases. Journal Of Neurosurgery Case Lessons 2022, 4: case21373. PMID: 35855352, PMCID: PMC9257400, DOI: 10.3171/case21373.Peer-Reviewed Original ResearchLaser interstitial thermal therapyRadiation necrosisInterstitial thermal therapyBrain metastasesAssociated cerebral edemaStage IV diseaseUse of immunotherapyPredictors of responseOngoing immunotherapySurgical decompressionCerebral edemaPerilesional edemaSurgical approachClinical historyLung cancerNeurological compromiseGood patientHistological changesStereotactic radiosurgeryPatientsEarly reductionSized lesionsImmunotherapyTherapyThermal therapyGraded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors
Sperduto PW, De B, Li J, Carpenter D, Kirkpatrick J, Milligan M, Shih HA, Kutuk T, Kotecha R, Higaki H, Otsuka M, Aoyama H, Bourgoin M, Roberge D, Dajani S, Sachdev S, Gainey J, Buatti JM, Breen W, Brown PD, Ni L, Braunstein S, Gallitto M, Wang TJC, Shanley R, Lou E, Shiao J, Gaspar LE, Tanabe S, Nakano T, An Y, Chiang V, Zeng L, Soliman H, Elhalawani H, Cagney D, Thomas E, Boggs DH, Ahluwalia MS, Mehta MP. Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors. International Journal Of Radiation Oncology • Biology • Physics 2022, 114: 60-74. PMID: 35331827, PMCID: PMC9378572, DOI: 10.1016/j.ijrobp.2022.03.020.Peer-Reviewed Original ResearchConceptsNon-small cell lung cancerSmall cell lung cancerGraded Prognostic AssessmentBrain metastasesSignificant prognostic factorsPrognostic factorsDeath ligand 1Cell lung cancerLung cancerPD-L1Lung adenocarcinomaMedian survivalNSCLC adenocarcinomaPrognostic assessmentInitial reportMulti-institutional retrospective databaseProgrammed Death Ligand 1PD-L1 1Tumor molecular statusOverall median survivalPD-L1 expressionLigand 1Anaplastic lymphoma kinaseEpidermal growth factor receptorGrowth factor receptor513 Surveilling Cerebrospinal Fluid Protein Biomarkers in Brain Metastasis
Cheok S, Arnal-Estape A, Wei W, Nguyen D, Chiang V. 513 Surveilling Cerebrospinal Fluid Protein Biomarkers in Brain Metastasis. Neurosurgery 2022, 68: 129-129. DOI: 10.1227/neu.0000000000001880_513.Peer-Reviewed Original ResearchBrain metastasesCerebrospinal fluidIntraparenchymal diseaseCentral nervous system pathologyCerebrospinal fluid (CSF) protein biomarkersIntraparenchymal brain metastasesManagement of patientsNormal pressure hydrocephalusNervous system pathologyCurrent diagnostic standardNon-malignant samplesWarrants further explorationCSF profilePressure hydrocephalusRadiation necrosisLung cancerSimilar pathogenesisBrain parenchymaInflammatory diseasesIntracranial diseaseBreast cancerClinical dataCSF leakTreatment responsePatients
2021
Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF)
Cifarelli C, Vargo J, Fang W, Liscak R, Guseynova K, Warnick R, Lee C, Yang H, Borghei-Razavi H, Maiti T, Siddiqui Z, Yuan J, Grills I, Mathieu D, Touchette C, Cordeiro D, Chiang V, Hess J, Tien C, Faramand A, Kano H, Barnett G, Sheehan J, Lunsford L. Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF). Neurosurgery 2021, 89: s20-s20. DOI: 10.1093/neuros/nyz428_s020.Peer-Reviewed Original ResearchReirradiation With Stereotactic Radiosurgery After Local or Marginal Recurrence of Brain Metastases From Previous Radiosurgery
Kowalchuk RO, Niranjan A, Lee CC, Yang HC, Liscak R, Guseynova K, Tripathi M, Kumar N, Peker S, Samanci Y, Hess J, Chiang V, Iorio-Morin C, Mathieu D, Pikis S, Wei Z, Lunsford LD, Trifiletti DM, Sheehan JP. Reirradiation With Stereotactic Radiosurgery After Local or Marginal Recurrence of Brain Metastases From Previous Radiosurgery. International Journal Of Radiation Oncology • Biology • Physics 2021, 112: 726-734. PMID: 34644606, DOI: 10.1016/j.ijrobp.2021.10.008.Peer-Reviewed Original ResearchConceptsLocal tumor controlRepeat stereotactic radiosurgeryRadiation necrosisStereotactic radiosurgeryBrain metastasesTumor controlMaximum doseMarginal recurrenceBiopsy-proven non-small cell lung cancerIsodose lineNon-small cell lung cancerRisk of RNPreoperative stereotactic radiosurgeryPrior stereotactic radiosurgerySymptomatic radiation necrosisNeuro-Oncology criteriaCell lung cancerPrescription isodose linePrevious radiosurgeryMargin dosePrimary endpointPrior immunotherapyLung cancerMajor indicationTumor volumeManagement of Brain Metastases
Collier E, Chiang V, Goldberg S. Management of Brain Metastases. Current Cancer Research 2021, 115-137. DOI: 10.1007/978-3-030-74028-3_6.Peer-Reviewed Original ResearchBrain metastasesSystemic therapyLocal therapyAsymptomatic brain metastasesNew systemic therapiesSource of morbidityInclusion of patientsMalignant brain tumorsQuality of lifeNew cancer treatmentsSignificant morbidityWorse prognosisPatient survivalCNS diseaseLung cancerClinical trialsBrain tumorsMetastasisNSCLCTherapyCancer treatmentSmall molecule drugsFrequent originMorbidityTreatment
2020
Multi-institutional retrospective review of stereotactic radiosurgery for brain metastasis in patients with small cell lung cancer without prior brain-directed radiotherapy.
Miccio JA, Barsky A, Gao S, Verma V, Noticewala SS, Jairam V, Johnson SB, Yu JB, Hansen JE, Aneja S, An Y, Decker RH, Bulent Omay S, Li J, Kurtz GA, Alonso-Basanta M, Lee JYK, Chiang VL, Park HS. Multi-institutional retrospective review of stereotactic radiosurgery for brain metastasis in patients with small cell lung cancer without prior brain-directed radiotherapy. Journal Of Radiosurgery And SBRT 2020, 7: 19-27. PMID: 32802575, PMCID: PMC7406345.Peer-Reviewed Original ResearchWhole brain radiotherapyBrain metastasesOverall survivalNeurologic deathSmall-cell lung cancer (SCLC) brain metastasesCell lung cancer brain metastasesLung cancer brain metastasesSalvage whole brain radiotherapyMulti-institutional retrospective reviewSmall cell lung cancerMost SCLC patientsSCLC brain metastasesTime of SRSMedian overall survivalCancer brain metastasesCell lung cancerIntracranial progressionSCLC patientsUpfront radiosurgeryBrain radiationBrain radiotherapySelect patientsRetrospective reviewLung cancerStereotactic radiosurgery
2019
Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF)
Cifarelli CP, Vargo JA, Fang W, Liscak R, Guseynova K, Warnick RE, Lee CC, Yang HC, Borghei-Razavi H, Maiti T, Siddiqui ZA, Yuan JC, Grills IS, Mathieu D, Touchette CJ, Cordeiro D, Chiang V, Hess J, Tien CJ, Faramand A, Kano H, Barnett GH, Sheehan JP, Lunsford LD. Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF). Neurosurgery 2019, 87: 664-671. PMID: 31599324, PMCID: PMC7780439, DOI: 10.1093/neuros/nyz428.Peer-Reviewed Original ResearchConceptsSmall cell lung cancerWhole-brain irradiationSCLC brain metastasesInternational Radiosurgery Research FoundationDistant brain failureBrain metastasesOverall survivalStereotactic radiosurgerySCLC patientsBrain failureLung cancerPrior whole-brain irradiationMulti-institutional retrospective reviewKaplan-Meier survival analysisCox proportional hazards modelLocal failureProphylactic cranial irradiationInstitutional retrospective studyMedian marginal doseOngoing prospective trialsCell lung cancerGamma knife radiosurgeryInstitutional review boardValue of radiosurgeryBinary logistic regression
2018
Durability of brain metastasis response and overall survival in patients with non-small cell lung cancer (NSCLC) treated with pembrolizumab.
Goldberg S, Gettinger S, Mahajan A, Herbst R, Chiang A, Lilenbaum R, Jilaveanu L, Rowen E, Gerrish H, Komlo A, Wei W, Chiang V, Kluger H. Durability of brain metastasis response and overall survival in patients with non-small cell lung cancer (NSCLC) treated with pembrolizumab. Journal Of Clinical Oncology 2018, 36: 2009-2009. DOI: 10.1200/jco.2018.36.15_suppl.2009.Peer-Reviewed Original Research
2017
Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA)
Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, Engelman A, Roberge D, Arvold ND, Alexander B, Awad MM, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta MP. Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncology 2017, 3: 827-831. PMID: 27892978, PMCID: PMC5824323, DOI: 10.1001/jamaoncol.2016.3834.Peer-Reviewed Original ResearchConceptsDiagnosis-Specific Graded Prognostic AssessmentBrain metastasesGraded Prognostic AssessmentFuture clinical trialsLung cancerLung-molGPAMedian survivalPrognostic factorsHazard ratioClinical trialsMAIN OUTCOMEPrognostic assessmentLung-molGPA scoreOverall median survivalKarnofsky performance statusMultiple Cox regressionSignificant prognostic factorsCell lung cancerRetrospective database analysisCancer-related mortalityLog-rank testHeterogeneous patient populationClinical decision makingExtracranial metastasesOverall survivalManagement of Brain Metastases in Tyrosine Kinase Inhibitor–Naïve Epidermal Growth Factor Receptor–Mutant Non–Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis
Magnuson WJ, Lester-Coll NH, Wu AJ, Yang TJ, Lockney NA, Gerber NK, Beal K, Amini A, Patil T, Kavanagh BD, Camidge DR, Braunstein SE, Boreta LC, Balasubramanian SK, Ahluwalia MS, Rana NG, Attia A, Gettinger SN, Contessa JN, Yu JB, Chiang VL. Management of Brain Metastases in Tyrosine Kinase Inhibitor–Naïve Epidermal Growth Factor Receptor–Mutant Non–Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis. Journal Of Clinical Oncology 2017, 35: jco.2016.69.714. PMID: 28113019, DOI: 10.1200/jco.2016.69.7144.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntineoplastic AgentsBrain NeoplasmsCarcinoma, Non-Small-Cell LungCombined Modality TherapyCranial IrradiationDisease-Free SurvivalErbB ReceptorsErlotinib HydrochlorideFemaleHumansLung NeoplasmsMaleMiddle AgedProtein Kinase InhibitorsRadiosurgeryRetrospective StudiesSalvage TherapySurvival RateConceptsWhole brain radiotherapyMulti-institutional analysisEGFR-mutant NSCLCBrain metastasesEGFR-TKIStereotactic radiosurgeryTyrosine kinase inhibitorsOverall survivalEpidermal growth factor receptorGrowth factor receptorIntracranial progressionLung cancerMutant non-small cell lung cancerEGFR-TKI resistance mutationNon-small cell lung cancerIntracranial progression-free survivalRetrospective multi-institutional analysisDeferral of radiotherapyEGFR-TKI useSimilar prognostic featuresUpfront EGFR-TKIProgression-free survivalFactor receptorInferior overall survivalCell lung cancer
2016
Deferring Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Non-Small Cell Lung Cancer: A Multi-Institutional Analysis
Magnuson W, Amini A, Patil T, Kavanagh B, Camidge D, Braunstein S, Boreta L, Attia A, Rana N, Contessa J, Gettinger S, Lester-Coll N, Yu J, Chiang V. Deferring Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Non-Small Cell Lung Cancer: A Multi-Institutional Analysis. International Journal Of Radiation Oncology • Biology • Physics 2016, 96: s57-s58. DOI: 10.1016/j.ijrobp.2016.06.149.Peer-Reviewed Original ResearchThe Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases
Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, Engelman A, Roberge D, Arvold ND, Alexander B, Awad MM, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta MP. The Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2016, 96: 406-413. PMID: 27598807, PMCID: PMC5575932, DOI: 10.1016/j.ijrobp.2016.06.006.Peer-Reviewed Original ResearchMeSH KeywordsAdenocarcinomaAgedAged, 80 and overAnaplastic Lymphoma KinaseAntineoplastic AgentsBrain NeoplasmsErbB ReceptorsFemaleGenetic MarkersGenetic Predisposition to DiseaseHumansIncidenceLung NeoplasmsMaleMiddle AgedMutationPolymorphism, Single NucleotidePrevalenceProtein-Tyrosine KinasesReceptor Protein-Tyrosine KinasesRetrospective StudiesRisk FactorsSurvival RateUnited StatesConceptsTyrosine kinase inhibitionBrain metastasesMedian survivalCause of deathGene alterationsDiagnosis of BMMulti-institutional retrospective databaseTKI-naïve patientsRisk of deathLonger median survivalKinase inhibitionALK gene alterationsTreatment patternsCancer mortalityLung cancerPrimary diagnosisRetrospective databaseCommon causeLung adenocarcinomaGroup overallPatientsFirst treatmentPrior trialsEGFRMonthsPembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial
Goldberg SB, Gettinger SN, Mahajan A, Chiang AC, Herbst RS, Sznol M, Tsiouris AJ, Cohen J, Vortmeyer A, Jilaveanu L, Yu J, Hegde U, Speaker S, Madura M, Ralabate A, Rivera A, Rowen E, Gerrish H, Yao X, Chiang V, Kluger HM. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. The Lancet Oncology 2016, 17: 976-983. PMID: 27267608, PMCID: PMC5526047, DOI: 10.1016/s1470-2045(16)30053-5.Peer-Reviewed Original ResearchConceptsProgressive brain metastasesUntreated brain metastasesBrain metastasis responseYale Cancer CenterBrain metastasesPhase 2 trialCell lung cancerAdverse eventsMetastasis responseCancer CenterLung cancerMelanoma cohortGrade 3 colitisGrade 3 fatigueGrade 3 pneumonitisPD-1 axisAcute kidney injuryNeurological adverse eventsPD-1 inhibitorsAcceptable safety profilePD-L1 expressionSystemic immunotherapyKidney injuryPrimary endpointNSCLC cohort