Management of Brain Metastases from Lung Cancer in the Era of Immunotherapy: a Review of the Literature

Veccia, Antonello; Kinspergher, Stefania; Dipasquale, Mariachiara; Caffo, Orazio

doi:10.2217/fon-2020-0701

Cited by 4 publications

(3 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Metastases to the brain, which manifest as neurological disorders, occur in 18% to 61% of patients with lung cancer and are associated with a poor prognosis ( 31 – 33 ). The role of chemotherapeutic agents in these patients is limited by the blood–brain barrier, but the introduction of targeted therapies and immune checkpoint inhibitors has radically changed the treatment algorithm for this patient population ( 34 ). Despite these changes, most previous studies have recruited only a small percentage of patients with brain metastases, which is not representative of the overall population.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

et al. 2022

View full text Add to dashboard Cite

The combination of immunotherapy and chemotherapy has a synergic effect in non-small cell lung cancer (NSCLC). However, the elderly are often excluded from clinical trails due to their poor health status and more comorbidities. We sought to assess the efficacy and safety of low-dose nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus tislelizumab (an anti-PD-1 antibody) in elderly patients with advanced NSCLC. In this phase 2 clinical trail, eligible patients were those aged ≥65 years with metastatic NSCLC who had disease progression after treatment with ≥1 line of chemotherapy or targeted therapy. Patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) variations were eligible if they demonstrated disease progression after treatment with ≥1 corresponding inhibitor. Primary endpoints were progression-free survival and safety/tolerability. Secondary endpoints included objective response rate and overall survival. Among 29 patients enrolled from May 2019 through August 2020, 21 (72.4%) had adenocarcinoma, 17 (58.6%) had a performance status of 2, 8 (27.6%) had asymptomatic brain metastases, and 13 (44.8%) had EGFR/ALK variations. As of the data cutoff point on April 1, 2021, median progression-free survival and overall survival were 9.5 months and 16.5 months, respectively. Ten patients achieved a partial response (objective response rate of 34.5%). Seventeen (58.6%) patients had ≥1 treatment-related adverse event, with grade 3 events seen in 3 patients (10.3%). The most common adverse events were fatigue (20.7%), fever (17.2%), abnormal liver function (17.2%), and rash (17.2%). These results suggest that low-dose nab-paclitaxel plus tislelizumab is well tolerated and effective in elderly patients with advanced NSCLC, including those with EGFR/ALK variations.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Nevertheless, IT and TT have revolutionized patient management and outcomes, particularly in lung cancer, melanoma, triplenegative or HER2-positive breast cancer [30][31][32][33][34][35]. Further studies including more patients are needed to explain the decrease in the rate of spread of new tumor cells and new distant BMs with repeated courses of SRT in patients on immunotherapy or targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Characteristics of Patients Treated for Brain Metastases with Repeat Stereotactic radiotherapy (SRT): A Retrospective Study of 184 Patients

Kuntz

Fèvre

Jarnet

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose Brain metastases (BMs) are the leading cause of intracranial malignant neoplasms in adults. WHO, Karnofsky performance status (KPS), age, number of BMs, extracerebral progression (ECP), recursive partitioning analysis (RPA), diagnosis-specific graded prognostic assessment (Ds-GPA) are validated prognostic tools to help clinicians decide on treatment. No consensus exists for repeat stereotactic radiotherapy (SRT) for BMs. The aim of this study was to review the changes in patient characteristics treated with repeated SRTs. Methods and Materials The data of patients treated between 2010 and 2020 with at least two courses of SRT without previous whole brain radiotherapy (WBRT) were reviewed. Age, WHO, KPS, ECP, type of systemic treatment, number of BMs were recorded. RPA, Ds-GPA and brain metastasis velocity (BMV) were calculated. Results 184 patients were treated for 915 BMs and received two to six SRTs for local or distant brain recurrence. The median number of BMs treated per SRT was 1 (range:1–6), for a median of 4 BMs treated during all sessions (range:2–19). WHO, Ds-GPA and RPA were stable between each session of SRT, whereas KPS was significantly better in SRT1 than in the following SRT. The number of BMs was not significantly different between each SRT, but there was a tendency for more BM at SRT1 (p = 0.06). At SRT1, patients had largest BM and undergo more surgery than during the following SRT (p < 0.001). 6.5%, 37.5% and 56% of patients were classified as high, intermediate, and low BMV, respectively, at the last SRT session. There was almost perfect concordance between the BMV-grade calculated at the last SRT session and at SRT2 (r = 0.89; p < 0.001). Conclusion Repeated SRT doesn't lead to a marked alteration in the general condition, KPS was maintained at over 70% for more than 95% of patients during all SRTs. Long survival can be expected, especially in low-grade BMV patients. WBRT shouldn't be aborted, especially for patients developing more than twelve BMs annually.

show abstract

“…Although immunotherapy has been successful in the management of primary lung tumors [ 3 – 5 ], evidence for the efficacy of immunotherapy for LCBM is mostly limited to retrospective analyses due to the frequent exclusion of patients with brain metastases from clinical trials [ 6 – 8 ]. Nevertheless, the few available prospective clinical trials seem promising [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Coordination of anti-CTLA-4 with whole-brain radiation therapy decreases tumor burden during treatment in a novel syngeneic model of lung cancer brain metastasis

Blethen,

Wolford,

Pecar

et al. 2024

Cancer Immunol Immunother

View full text Add to dashboard Cite

Lung cancer is the most common primary tumor to metastasize to the brain. Although advances in lung cancer therapy have increased rates of survival over the past few decades, control and treatment of lung cancer brain metastasis remains an urgent clinical need. Herein, we examine the temporal coordination of α-CTLA-4 administration in combination with whole-brain radiation therapy in a syngeneic preclinical model of lung cancer brain metastasis in both C57Bl/6 and athymic nude mice. Brain tumor burden, survival, and weight loss were monitored. Immunotherapy administration 24 h prior to irradiation resulted in increased brain tumor burden, while administration of immunotherapy 12 h after radiation decreased tumor burden. Neither of the treatments affected survival outcomes or weight loss due to brain tumor recurrence. These findings suggest that the coordination of α-CTLA-4 administration in addition to whole-brain radiation therapy may be a viable strategy for reduction of tumor burden for the management of lung cancer brain metastasis.

show abstract

Management of Brain Metastases from Lung Cancer in the Era of Immunotherapy: a Review of the Literature

Cited by 4 publications

References 51 publications

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer

Changes in the Characteristics of Patients Treated for Brain Metastases with Repeat Stereotactic radiotherapy (SRT): A Retrospective Study of 184 Patients

Coordination of anti-CTLA-4 with whole-brain radiation therapy decreases tumor burden during treatment in a novel syngeneic model of lung cancer brain metastasis

Contact Info

Product

Resources

About