Do TTFields work synergistically with SRS for patients with brain metastases?
Based on the presented data from the METIS trial, yes, TTFields works synergistically with SRS for patients with NSCLC brain metastases. It is not clear on the mechanism of action. It appears there is even greater synergy with use of ICI. One hypothesis is whether there is enhanced immune response, such as with an increase in CD8+ T cell tumor infiltration, and whether this enhances tumor cell kill outside the lesions treated with SRS to prevent the development of new brain metastases.
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In terms of the synergy of TTFields with radiation, we have little direct data for confirmatory validation of this interaction. However, there are some limited data that suggest that there is synergy between TTFields and several other therapeutic modalities, including chemotherapy and radiotherapy. As to the specifics of the extent of synergy, specifically with radiosurgery, little is known about this. In this trial, the two modalities were combined not so much for the potential synergy but more so for enhancing microscopic control of disease in the rest of the brain, which would not be treated with stereotactic radiosurgery. We did see improved local control of the radiosurgically treated lesions with TTFields, implying the potential for...
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Dr. @Dr. First Last presented as the discussant, the rationale for synergism with ICI. The improvement in local control seen does imply synergism with SRS, as Dr. @Dr. First Last mentioned.
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