Research Progress and Challenges in the Treatment of Central Nervous System Metastasis of Non-Small Cell Lung Cancer

Abstract

Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors and has high morbidity and mortality rates. Central nervous system (CNS) metastasis is one of the most frequent complications in patients with NSCLC and seriously affects the quality of life (QOL) and overall survival (OS) of patients, with a median OS of untreated patients of only 1–3 months. There are various treatment methods for NSCLC CNS metastasis, including surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy, which do not meet the requirements of patients in terms of improving OS and QOL. There are still many problems in the treatment of NSCLC CNS metastasis that need to be solved urgently. This review summarizes the research progress in the treatment of NSCLC CNS metastasis to provide a reference for clinical practice.

Influence of Helicobacter pylori infection on PD‐1/PD‐L1 blockade therapy needs more attention

“…In addition, both nivolumab and pembrolizumab showed higher progression‐free survival, overall survival, and objective response rates for various different types of malignant melanoma than that shown by conventional chemotherapy and ipilimumab monotherapy 10‐12 . In non‐small‐cell lung cancer (NSCLC), nivolumab has been approved as a second‐line treatment for advanced NSCLC in many countries, based on improved overall survival and favorable safety 13,14 . Moreover, patients treated with nivolumab exhibited a fivefold increase in 5‐year overall survival (OS) and a significantly improved progression‐free survival (PFS) compared to patients treated with docetaxel 15 .…”

“…[10][11][12] In non-small-cell lung cancer (NSCLC), nivolumab has been approved as a second-line treatment for advanced NSCLC in many countries, based on improved overall survival and favorable safety. 13,14 Moreover, patients treated with nivolumab exhibited a fivefold increase in 5-year overall survival (OS) and a significantly improved progression-free survival (PFS) compared to patients treated with docetaxel. 15 In clinical trials of hepatocellular carcinoma, refractory esophageal carcinoma, metastatic renal carcinoma, urinary tract carcinoma, and endometrial carcinoma, treatment with an anti-PD-1/PD-L1 antibody has improved OS, PFS, and objective response rate (ORR).…”

Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study

“…Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancers. The central nervous system (CNS) is one of the most common sites of distant metastasis from advanced NSCLC ( 2 ). Due to the severe clinical symptoms and the serious effects on the quality of life of these patients, CNS metastasis serves as one of the main causes of death in patients with NSCLC, and is drawing increasing clinical and research attention in recent years.…”

“…CNS metastasis includes brain metastasis (BM), leptomeningeal metastasis (LM), intramedullary spinal cord metastasis (ISCM), etc. ( 2 , 3 ). BM is the most common type of CNS metastasis in NSCLC patients and is found in up to 40–50% of advanced NSCLC patients during their disease course.…”

“…Local and systemic treatments are used for managing NSCLC patients with CNS metastasis. The appropriate treatment for CNS metastasis could relieve neurological symptoms, improve quality of life, and prolong OS ( 2 , 10 ). Owing to the development of small-molecule targeted drugs and immune checkpoint inhibitors (ICIs), as well as new surgical techniques and radiotherapy techniques, the systemic treatment and local treatment paradigms for CNS metastasis from NSCLC with or without driver genes are different.…”