Something to Bragg about.

Phase 1 data has suggested quite notable survival times can be achieved with proton craniospinal irradiation (CSI) for well-selected patients with leptomeningeal disease. We know what protons for LMD has you thinking…overkill. Well, how about underkill. We now have reporting on the larger randomized phase 2 version, and it’s nothing short of eyebrow raising. Over 1.5 years, patients with LMD from breast or non-small cell lung cancer (NSCLC) were randomized 2:1 to proton CSI  (n=42) versus the standard photon treatment to whole brain or involved spine (n=21). All prescriptions were 30Gy/10. The primary endpoint of time to CNS progression was a median of 2 months after standard photon involved-site treatment and 7.5 months (!) after proton CSI. If that’s not enough, the secondary endpoint of overall survival was also improved from a median of 5 to >8 months, representing a huge advancement in therapy for LMD. | Yang, ASCO 2022