Who’s on deck?

Immune checkpoint inhibition (ICI) arrived on the scene rapidly, and unfortunately quite disjointedly from the concurrent rise in radiosurgery. That’s left a lot in the onc community wondering who should go first in the treatment of brain mets. This small retrospective analysis of melanoma brain mets (with or without symptoms) purports that radiation → ICI (n=11) was associated with better survival than ICI → radiation (n=6). But, come on. These numbers are questionably more than anecdotal, and requiring radiation after ICI in and of itself indicates a poor systemic response. What’s more intriguing is their look at transcriptome changes among brain mets resected before or after radiation. TBL: Radiation to melanoma brian mets induces changes in the NF-kB signaling pathway that appear to prime a response to subsequent ICI. | Krummel, Int J Radiat Oncol Biol Phys 2020