Concurrent whole brain radiotherapy and bortezomib for brain metastasis

Christopher D. Lao, Judah Friedman, Christina I. Tsien, Daniel P. Normolle, Christopher Chapman, Yue Cao, Oliver Lee, Matt Schipper, Catherine Van Poznak, Daniel Hamstra, Theodore Lawrence, James Hayman, Bruce G. Redman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Survival of patients with brain metastasis particularly from historically more radio-resistant malignancies remains dismal. A phase I study of concurrent bortezomib and whole brain radiotherapy was conducted to determine the tolerance and safety of this approach in patients with previously untreated brain metastasis.Methods: A phase I dose escalation study evaluated the safety of bortezomib (0.9, 1.1, 1.3, 1.5, and 1.7 mg/m2) given on days 1, 4, 8 and 11 of whole brain radiotherapy. Patients with confirmed brain metastasis were recruited for participation. The primary endpoint was the dose-limiting toxicity, defined as any ≥ grade 3 non-hematologic toxicity or grade ≥ 4 hematologic toxicity from the start of treatment to one month post irradiation. Time-to-Event Continual Reassessment Method (TITE-CRM) was used to determine dose escalation. A companion study of brain diffusion tensor imaging MRI was conducted on a subset of patients to assess changes in the brain that might predict delayed cognitive effects.Results: Twenty-four patients were recruited and completed the planned therapy. Patients with melanoma accounted for 83% of all participants. The bortezomib dose was escalated as planned to the highest dose of 1.7 mg/m2/dose. No grade 4/5 toxicities related to treatment were observed. Two patients had grade 3 dose-limiting toxicities (hyponatremia and encephalopathy). A partial or minor response was observed in 38% of patients. Bortezomib showed greater demyelination in hippocampus-associated white matter structures on MRI one month after radiotherapy compared to patients not treated with bortezomib (increase in radial diffusivity +16.8% versus 4.8%; p = 0.0023).Conclusions: Concurrent bortezomib and whole brain irradiation for brain metastasis is well tolerated at one month follow-up, but MRI changes that have been shown to predict delayed cognitive function can be detected within one month of treatment.

Original languageEnglish (US)
Article number204
JournalRadiation Oncology
Volume8
Issue number1
DOIs
StatePublished - Aug 21 2013
Externally publishedYes

Keywords

  • Bortezomib
  • Brain
  • Diffusion tensor imaging
  • MRI
  • Melanoma
  • Phase I
  • Radiation
  • TITE-CRM

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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