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Kilickap S, Özgüroğlu M, Sezer A, Gümüş M, Bondarenko I, Gogishvili M, Turk HM, Cicin I, Bentsion D, Gladkov O, Sriuranpong V, Quek RGW, McIntyre DAG, He X, McGinniss J, Seebach F, Gullo G, Rietschel P, Pouliot J. Cemiplimab monotherapy as first-line treatment of patients with brain metastases from advanced non-small cell lung cancer with programmed cell death-ligand 1 ≥50. Cancer 2025; 131:e35864. [PMID: 40323717 PMCID: PMC12051739 DOI: 10.1002/cncr.35864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 02/13/2025] [Accepted: 02/20/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND In the phase 3 EMPOWER-Lung 1 study, first-line cemiplimab monotherapy provided significant survival benefit versus chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) ≥50%. This exploratory subgroup analysis investigated the clinical outcomes of cemiplimab treatment in patients with advanced NSCLC with brain metastases. METHODS Patients with advanced NSCLC were randomized (1:1) to cemiplimab 350 mg every 3 weeks or four cycles of platinum doublet chemotherapy (NCT03088540). Patients with symptomatic radiotherapy-treated brain metastases were eligible to enroll. Of the 565 patients with confirmed PD-L1 expression ≥50%, 69 (12%) had brain metastases at baseline. RESULTS Patients with brain metastases who received cemiplimab had a median overall survival (OS) of 52.4 months compared with 20.7 months for those who received chemotherapy (hazard ratio [HR], 0.40; p = .0031) and a median progression-free survival (PFS) of 12.5 versus 5.3 months (HR, 0.33; p = .0002), respectively. Patients without brain metastases had a median OS of 24.3 months with cemiplimab versus 12.5 months with chemotherapy (HR, 0.63; p < .0001); their median PFS was 6.5 months versus 5.2 months (HR, 0.55; p < .0001), respectively. Cemiplimab was associated with a significant improvement in global health status/quality of life in all patients, including those with brain metastases. The cemiplimab safety profile was generally similar in all patients. CONCLUSIONS In patients with advanced NSCLC with PD-L1 ≥50%, first-line cemiplimab monotherapy improved survival and patient-reported outcomes over chemotherapy for those who received prior radiotherapy for symptomatic brain metastases.
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MESH Headings
- Humans
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Brain Neoplasms/secondary
- Brain Neoplasms/drug therapy
- Brain Neoplasms/mortality
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Female
- Lung Neoplasms/pathology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Male
- Middle Aged
- B7-H1 Antigen/metabolism
- Aged
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aged, 80 and over
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
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Affiliation(s)
- Saadettin Kilickap
- Department of Medical OncologyIstinye University Faculty of MedicineIstanbulTurkey
| | - Mustafa Özgüroğlu
- Cerrahpaşa Medical FacultyIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Ahmet Sezer
- Department of Medical OncologyBaşkent UniversityAdanaTurkey
| | - Mahmut Gümüş
- Department of Medical OncologySchool of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Igor Bondarenko
- Department of Oncology and Medical RadiologyDnipropetrovsk Medical AcademyDniproUkraine
| | | | - Haci M. Turk
- Department of Medical OncologyBezmialem Vakif University, Medical FacultyIstanbulTurkey
| | - Irfan Cicin
- Istinya University Faculty of Medicine, Florya Medical Park HospitalIstanbulTurkey
| | - Dmitry Bentsion
- Radiotherapy DepartmentSverdlovsk Regional Oncology CentreSverdlovskRussia
| | | | - Virote Sriuranpong
- Division of Medical OncologyDepartment of MedicineFaculty of MedicineChulalongkorn University and the King Chulalongkorn Memorial HospitalBangkokThailand
| | | | | | - Xuanyao He
- Regeneron Pharmaceuticals, IncTarrytownNew YorkUSA
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2
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Wang J, Zhang Y, Bai R, Wu Y, Tong Z, Liu A, Zhang Y, Wang H, Wu X, Cheng Y, Yang H, Zhou Q, Xing X, Chen X, Qiu F, Ma F. Novel TROP2 antibody-drug conjugates for treatment of HER2-negative metastatic breast cancer patients with brain metastases: a promising option ☆. ESMO Open 2025; 10:105059. [PMID: 40359710 DOI: 10.1016/j.esmoop.2025.105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/17/2025] [Accepted: 03/25/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND ESG401 is a further optimized antibody-drug conjugate comprising a humanized anti-trophoblast cell-surface antigen 2 immunoglobulin G1 monoclonal antibody conjugated to SN-38, a topoisomerase I inhibitor, via a proprietary novel stable linker. The analysis aimed to explore the efficacy of ESG401 in human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC) patients with brain metastases (BMs), a population urging significant clinical need with limited systematic treatment options. PATIENTS AND METHODS This subgroup analysis was conducted as part of an open-label, multi-dose, dose-escalation, and cohort-expansion multicenter phase I trial. Eligible participants were aged 18-75 years and had locally advanced or metastatic solid tumors. For this subgroup analysis, patients with histologically confirmed HER2-negative BC and BMs were enrolled. Efficacy endpoints included overall objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS). Intracranial-specific endpoints included intracranial ORR (iORR), intracranial DCR (iDCR), and intracranial PFS. This trial is registered at ClinicalTrials.gov, NCT04892342. RESULTS Among 17 patients with efficacy-evaluable BMs, the iORR was 41% (7/17) [95% confidence interval (CI) 18.4% to 67.1%] including 3 patients achieving an intracranial complete response. The iDCR was 76% (13/17) (95% CI 50.1% to 93.2%). The overall ORR was 53% (9/17) (95% CI 27.8% to 77.0%), the overall DCR was 71% (12/17) (95% CI 44.0% to 89.7%), and the medium PFS was 5.7 months. The safety profile was consistent with previous reports. CONCLUSIONS These findings suggest that ESG401 is a promising and well-tolerated treatment option for BMs.
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Affiliation(s)
- J Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Zhang
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - R Bai
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Y Wu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Z Tong
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - A Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Y Zhang
- Department of Oncology, Beijing Hospital, Beijing, China
| | - H Wang
- Department of Oncology, Nanchang People's Hospital Affiliated of Nanchang Medical College, Nanchang, China
| | - X Wu
- Department of Oncology, Hubei Cancer Hospital, Hubei, China
| | - Y Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun, China
| | - H Yang
- Department of Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Q Zhou
- Shanghai Escugen Biotechnology Co., Ltd, Shanghai, China
| | - X Xing
- Shanghai Escugen Biotechnology Co., Ltd, Shanghai, China
| | - X Chen
- Shanghai Escugen Biotechnology Co., Ltd, Shanghai, China
| | - F Qiu
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - F Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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3
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Bruzzone F, Barigazzi C, Di Muzio A, Tallarico I, Dipasquale A, Losurdo A, Persico P, Navarria P, Pessina F, Santoro A, Simonelli M. Exploring the Role of ADCs in Brain Metastases and Primary Brain Tumors: Insight and Future Directions. Cancers (Basel) 2025; 17:1591. [PMID: 40361515 PMCID: PMC12072133 DOI: 10.3390/cancers17091591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2025] [Revised: 04/28/2025] [Accepted: 05/02/2025] [Indexed: 05/15/2025] Open
Abstract
Primary and secondary brain tumors have always been a challenge due to their high morbidity and poor prognosis. The incidence of brain metastasis is also increasing with the advent of effective new treatments. Traditional systemic treatments have historically had limited success, partly due to poor central nervous system (CNS) penetration. However, the advent in recent decades of new therapies that have shown high encephalic response rates are challenging this paradigm. ADCs represent a new class of compounds revolutionizing cancer treatment with high systemic response rates and lower toxicities. The continuing evolution of ADCs has shown that certain structural features such as payload, linker, and drug-to-antibody ratio (DAR) are essential in determining their efficacy at the encephalic level, and some ADCs have started to exhibit promising efficacy in treating primary and secondary brain tumors. Unfortunately, most patients with untreated encephalic metastases are excluded from clinical trials, with data primarily from retrospective studies or post hoc analyses. This review describes the early signs of ADC efficacy in brain tumors, the role of complementary treatments like radiation therapy, and critical points to improve ADC efficacy in brain malignancies.
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Affiliation(s)
- Francesco Bruzzone
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Chiara Barigazzi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Antonio Di Muzio
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Isabel Tallarico
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Angelo Dipasquale
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
| | - Agnese Losurdo
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Pasquale Persico
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
| | - Matteo Simonelli
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.B.); (C.B.); (A.D.M.); (I.T.); (A.D.); (A.L.); (P.P.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
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Mansouri A, Ozair A, Bhanja D, Wilding H, Mashiach E, Haque W, Mikolajewicz N, de Macedo Filho L, Mahase SS, Machtay M, Metellus P, Dhermain F, Sheehan J, Kondziolka D, Lunsford LD, Niranjan A, Minniti G, Li J, Kalkanis SN, Wen PY, Kotecha R, McDermott MW, Bettegowda C, Woodworth GF, Brown PD, Sahgal A, Ahluwalia MS. Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care. Nat Rev Clin Oncol 2025; 22:327-347. [PMID: 40108412 DOI: 10.1038/s41571-025-01013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2025] [Indexed: 03/22/2025]
Abstract
The management of brain metastases is challenging and should ideally be coordinated through a multidisciplinary approach. Stereotactic radiosurgery (SRS) has been the cornerstone of management for most patients with oligometastatic central nervous system involvement (one to four brain metastases), and several technological and therapeutic advances over the past decade have broadened the indications for SRS to include polymetastatic central nervous system involvement (>4 brain metastases), preoperative application and fractionated SRS, as well as combinatorial approaches with targeted therapy and immune-checkpoint inhibitors. For example, improved imaging and frameless head-immobilization technologies have facilitated fractionated SRS for large brain metastases or postsurgical cavities, or lesions in proximity to organs at risk. However, these opportunities come with new challenges and questions, including the implications of tumour histology as well as the role and sequencing of concurrent systemic treatments. In this Review, we discuss these advances and associated challenges in the context of ongoing clinical trials, with insights from a global group of experts, including recommendations for current clinical practice and future investigations. The updates provided herein are meaningful for all practitioners in clinical oncology.
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Affiliation(s)
- Alireza Mansouri
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
- Penn State Cancer Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
- Department of Neurosurgery, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | - Ahmad Ozair
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Debarati Bhanja
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Hannah Wilding
- Department of Neurosurgery, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Elad Mashiach
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Waqas Haque
- Division of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicholas Mikolajewicz
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leonardo de Macedo Filho
- Penn State Cancer Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurosurgery, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Sean S Mahase
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Philippe Metellus
- Department of Neurosurgery, Ramsay Santé, Hôpital Privé Clairval, Marseille, France
| | - Frédéric Dhermain
- Radiation Therapy Department, Institut Gustave Roussy, Villejuif, France
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza IRCCS Neuromed, Pozzilli, Italy
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael W McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Graeme F Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Brain Tumour Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
- University of Maryland-Medicine Institute for Neuroscience Discovery, Baltimore, MD, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Manmeet S Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
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Zhang B, Song Y, Min Q, Cheng W, Wang J, Fu Y, Yin J. The administration sequences of immune checkpoint inhibitors and chemotherapy cause discrete efficacy when treating non-small cell lung cancer: a retrospective study. Front Immunol 2025; 16:1579420. [PMID: 40356932 PMCID: PMC12066507 DOI: 10.3389/fimmu.2025.1579420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/08/2025] [Indexed: 05/15/2025] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) combined with chemotherapy have become a standard first-line treatment for advanced non-small cell lung cancer (NSCLC). However, the optimal sequence of administrating the two treatments remains controversial. Methods This study included advanced NSCLC patients who received ICIs combined with chemotherapy at Renmin Hospital of Wuhan University and Xiangyang Hospital, Hubei University of Chinese Medicine between 1st September 2020 and 30th September 2024. Patients were categorized into the concurrent, immune-chemo, and chemo-immune groups based on different sequences of treatment administration. The primary endpoints evaluated were survival and treatment efficacy. The secondary endpoint assessed was treatment-related adverse events (TRAEs). Results This two-center, retrospective study included 270 NSCLC patients who received ICIs plus chemotherapy. Survival analysis revealed statistically significant differences across treatment groups. The median overall survival (mOS) durations were 636 days (concurrent group), 615 days (immune-chemo group), and 749 days (chemo-immune group), with a log-rank test demonstrating significant intergroup differences (P = 0.0017). Similarly, median progression-free survival (mPFS) showed distinct patterns at 178 days, 180 days, and 216 days for the respective groups (log-rank P = 0.0134). Additionally, the objective response rates (ORRs) for the three groups were 55.82% (72/129), 58.21% (39/67), and 68.92% (51/74), respectively. The incidence of TRAEs of any grade in the concurrent, the immune-chemo, and the chemo-immune groups was 77.52% (100/129), 65.67% (44/67), and 59.46% (44/74) rates, respectively, which was a significant difference (χ²=7.91, P=0.019). Despite patients experiencing Grade 3 or higher TRAEs had extremely poor prognoses, overall, patients who developed any grade of TRAEs had better survival outcomes, particularly those with skin or endocrine toxicity. Conclusions These findings suggest that the administration sequence of chemotherapy followed by ICIs may yield the greatest clinical benefit, providing a basis for clinical decision-making.
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Affiliation(s)
- Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuxiao Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Min
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weiting Cheng
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yang Fu
- Department of Oncology and Hematology, Xiangyang Hospital, Hubei University of Chinese Medicine, Xiangyang, China
| | - Jiaxin Yin
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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6
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Liu B, Chen J, Luo M. Efficacy and safety of immune checkpoint inhibitors for brain metastases of non-small cell lung cancer: a systematic review and network meta-analysis. Front Oncol 2025; 15:1513774. [PMID: 40308503 PMCID: PMC12040931 DOI: 10.3389/fonc.2025.1513774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 03/26/2025] [Indexed: 05/02/2025] Open
Abstract
Background Previous studies have demonstrated that immune checkpoint inhibitors (ICIs) significantly improve prognosis in lung cancer patients with brain metastases (BMs). This systematic review and network meta-analysis aims to evaluate the efficacy and safety of 10 ICIs recommended by the 2024 Chinese Society of Clinical Oncology guidelines for treating non-small cell lung cancer (NSCLC) without driver genes, focusing on NSCLC patients presenting with BMs. Materials and methods A comprehensive literature search of PubMed, Embase, and the Cochrane Library was conducted through June 2024 to identify eligible controlled trials and head-to-head randomized controlled trials investigating 10 ICIs in NSCLC patients with BMs. Pairwise and network meta-analyses were performed using hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs). Treatment efficacy was ranked hierarchically through the surface under the cumulative ranking curve (SUCRA). Results Sixteen trials from 11 studies, encompassing 1,274 NSCLC patients with BMs, were included. The meta-analysis demonstrated that ICIs significantly improved overall survival (OS: HR, 0.66; 95% CI, 0.52-0.85; P = 0.001) and progression-free survival (PFS: HR, 0.67; 95% CI, 0.54-0.84; P < 0.001). SUCRA ranking identified pembrolizumab as the most effective agent for OS improvement (SUCRA 71%), while camrelizumab showed superior PFS benefits (SUCRA 92%). ICIs were associated with increased objective response rates (RR: 1.52; 95% CI, 1.13-2.06; P = 0.006), but elevated risks of immune-mediated adverse events (RR: 2.50; 95% CI, 1.46-4.30; P = 0.001) and grade 3-5 immune-mediated adverse events and infusion reaction (RR: 6.39; 95% CI, 1.53-26.69; P = 0.011). Conclusion ICIs demonstrate superior survival benefits compared to chemotherapy in NSCLC patients with BMs, with pembrolizumab and camrelizumab emerging as optimal choices for OS and PFS improvement, respectively. However, vigilant monitoring of immune-mediated adverse events and infusion reactions remains critical in clinical practice.
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Affiliation(s)
- Bin Liu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Chen
- School of Biological Engineering, Wuhan Polytechnic, Wuhan, China
| | - Mingqi Luo
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
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7
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Coniac S, Costache-Outas MC, Antone-Iordache IL, Barbu AM, Bardan VT, Zamfir A, Ionescu AI, Badiu C. Real-World Evaluation of Immune-Related Endocrinopathies in Metastatic NSCLC Patients Treated with ICIs in Romania. Cancers (Basel) 2025; 17:1198. [PMID: 40227797 PMCID: PMC11987770 DOI: 10.3390/cancers17071198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/28/2025] [Accepted: 03/28/2025] [Indexed: 04/15/2025] Open
Abstract
(1) Background: Exploring real-world data (RWD) regarding immune-related adverse events (irAEs) is crucial to better understand the efficacy and safety of immunotherapy in cancer patient populations excluded from clinical trials. An analysis was conducted to evaluate the presumptive predictive causality between endocrine irAEs and the efficacy of immune check-point inhibitors (ICIs) in metastatic non-small-cell lung cancer (mNSCLC) patients treated in daily practice in Romania. (2) Methods: This was a retrospective cohort study of mNSCLC patients treated with ICIs in a tertiary level hospital in Romania for a period of almost seven years, from November 2017 till July 2024. Endocrine irAEs were well defined as any occurring autoimmune endocrinopathy during ICIs and related to immunotherapy. The hospital endocrinologist (M.C.C.O) diagnosed, treated, and followed these endocrine irAEs in a multidisciplinary approach. We investigated multiple medical variables to assess their impact on ICI effectiveness. Descriptive and statistical analyses were performed. (3) Results: Of 487 cancer patients treated with ICIs, we identified 215 mNSCLC patients who were evaluated for endocrine irAEs and co-medications during ICI therapy. Forty-seven (21.8%) patients experienced endocrine irAEs, thyroiditis being the most frequent and prevalent autoimmune endocrinopathy in 60% of cases. Endocrine irAEs were statistically significant, correlated with ICI efficacy (p = 0.002) for survival analysis. Steroids and proton-pump inhibitors used as co-medication during ICIs had a negative impact on response to therapy. (4) Conclusions: Endocrine irAEs might be considered predictive biomarkers for successful immunotherapy in mNSCLC patients. Co-medication during ICIs had a major influence on the effectiveness of these cutting-edge therapies. RWD plays an important role for oncology daily practice whenever clinical trial evidence is not available to guide decision.
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Affiliation(s)
- Simona Coniac
- Department of Medical Oncology, Hospice Hope Bucharest, 023642 Bucharest, Romania;
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
| | | | | | - Ana-Maria Barbu
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
| | - Victor Teodor Bardan
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
| | - Andreea Zamfir
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
| | - Andreea-Iuliana Ionescu
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
- Department of Radiotherapy, Coltea Clinical Hospital, 030167 Bucharest, Romania;
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Corin Badiu
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (V.T.B.); (A.Z.); (C.B.)
- C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
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8
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Wang M, Yang J, Wang S, Gill H, Cheng H. Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions. Curr Oncol 2025; 32:171. [PMID: 40136375 PMCID: PMC11941645 DOI: 10.3390/curroncol32030171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/09/2025] [Accepted: 03/15/2025] [Indexed: 03/27/2025] Open
Abstract
Brain metastases (BMs) are a relatively common and severe complication in advanced non-small cell lung cancer (NSCLC), significantly affecting patient prognosis. Metastatic tumor cells can alter the brain tumor microenvironment (TME) to promote an immunosuppressive state, characterized by reduced infiltration of tumor-infiltrating lymphocytes (TILs), diminished expression of programmed death-ligand 1 (PD-L1), and changes in other proinflammatory factors and immune cell populations. Microglia, the resident macrophages of the brain, play a pivotal role in modulating the central nervous system (CNS) microenvironment through interactions with metastatic cancer cells, astrocytes, and infiltrating T cells. The M2 phenotype of microglia contributes to immunosuppression in BM via the activation of signaling pathways such as STAT3 and PI3K-AKT-mTOR. Recent advances have enhanced our understanding of the immune landscape of BMs in NSCLC, particularly regarding immune evasion within the CNS. Current immunotherapeutic strategies, including immune checkpoint inhibitors, have shown promise for NSCLC patients with BM, demonstrating intracranial activity and manageable safety profiles. Future research is warranted to further explore the molecular and immune mechanisms underlying BM, aiming to develop more effective treatments.
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Affiliation(s)
- Meng Wang
- Department of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.W.)
| | - Jihua Yang
- Department of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.W.)
| | - Shuai Wang
- Department of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.W.)
| | - Harjot Gill
- Department of Pathology, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Haiying Cheng
- Department of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.W.)
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9
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Ninomiya T, Kemmotsu N, Mukohara F, Magari M, Miyamoto A, Ueda Y, Ishino T, Nagasaki J, Fujiwara T, Yamamoto H, Hayashi H, Tachibana K, Ishida J, Otani Y, Tanaka S, Toyooka S, Okamoto I, Togashi Y. Myeloid Cells Induce Infiltration and Activation of B Cells and CD4+ T Follicular Helper Cells to Sensitize Brain Metastases to Combination Immunotherapy. Cancer Res 2025; 85:1082-1096. [PMID: 39804971 DOI: 10.1158/0008-5472.can-24-2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/23/2024] [Accepted: 01/06/2025] [Indexed: 01/16/2025]
Abstract
Brain metastasis is a poor prognostic factor in patients with cancer. Despite showing efficacy in many extracranial tumors, immunotherapy with anti-PD-1 mAb or anti-CTLA4 mAb seems to be less effective against intracranial tumors. Promisingly, recent clinical studies have reported that combination therapy with anti-PD-1 and anti-CTLA4 mAbs has a potent antitumor effect on brain metastasis, highlighting the need to elucidate the detailed mechanisms controlling the intracranial tumor microenvironment (TME) to develop effective immunotherapeutic strategies. In this study, we analyzed the tumor-infiltrating lymphocytes in murine models of brain metastasis that responded to anti-CTLA4 and anti-PD-1 mAbs. Activated CD4+ T follicular helper (TFH) cells with high CTLA4 expression characteristically infiltrated the intracranial TME, which were activated by combination anti-CTLA4 and anti-PD-1 treatment. The loss of TFH cells suppressed the additive effect of CTLA4 blockade on anti-PD-1 mAb. B-cell-activating factor belonging to the TNF family (BAFF) and a proliferation-inducing ligand (APRIL) produced by abundant myeloid cells, particularly CD80hiCD206lo proinflammatory M1-like macrophages, in the intracranial TME induced B-cell and TFH-cell infiltration and activation. Furthermore, the intracranial TME of patients with non-small cell lung cancer featured TFH- and B-cell infiltration as tertiary lymphoid structures. Together, these findings provide insights into the immune cell cross-talk in the intracranial TME that facilitates an additive antitumor effect of CTLA4 blockade with anti-PD-1 treatment, supporting the potential of a combination immunotherapeutic strategy for brain metastases. Significance: B-cell and CD4+ T follicular helper cell activation via BAFF/APRIL from abundant myeloid cells in the intracranial tumor microenvironment enables a combinatorial effect of CTLA4 and PD-1 blockade in brain metastases.
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Affiliation(s)
- Toshifumi Ninomiya
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Kemmotsu
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Fumiaki Mukohara
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Masaki Magari
- Applied Cell Biology, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Ai Miyamoto
- Medical Protein Engineering, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Youki Ueda
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takamasa Ishino
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Joji Nagasaki
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hidetaka Yamamoto
- Department of Pathology and Oncology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kota Tachibana
- Department of Dermatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Joji Ishida
- Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshihiro Otani
- Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shota Tanaka
- Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yosuke Togashi
- Department of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
- Kindai University Faculty of Medicine, Osaka, Japan
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10
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Ding J, Jiang Y, Jiang N, Xing S, Ge F, Ma P, Tang Q, Miao H, Zhou J, Fang Y, Cui D, Liu D, Han Y, Yu W, Wang Y, Zhao G, Cai Y, Wang S, Sun N, Li N. Bridging the gap: unlocking the potential of emerging drug therapies for brain metastasis. Brain 2025; 148:702-722. [PMID: 39512184 DOI: 10.1093/brain/awae366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/30/2024] [Accepted: 09/29/2024] [Indexed: 11/15/2024] Open
Abstract
Brain metastasis remains an unmet clinical need in advanced cancers with an increasing incidence and poor prognosis. The limited response to various treatments is mainly derived from the presence of the substantive barrier, blood-brain barrier (BBB) and brain-tumour barrier (BTB), which hinders the access of potentially effective therapeutics to the metastatic tumour of the brain. Recently, the understanding of the structural and molecular features of the BBB/BTB has led to the development of efficient strategies to enhance BBB/BTB permeability and deliver drugs across the BBB/BTB to elicit the anti-tumour response against brain metastasis. Meanwhile, novel agents capable of penetrating the BBB have rapidly developed and been evaluated in preclinical studies and clinical trials, with both targeted therapies and immunotherapies demonstrating impressive intracranial activity against brain metastasis. In this review, we summarize the recent advances in the biological properties of the BBB/BTB and the emerging strategies for BBB/BTB permeabilization and drug delivery across the BBB/BTB. We also discuss the emerging targeted therapies and immunotherapies against brain metastasis tested in clinical trials. Additionally, we provide our viewpoints on accelerating clinical translation of novel drugs into clinic for patients of brain metastasis. Although still challenging, we expect this review to benefit the future development of novel therapeutics, specifically from a clinical perspective.
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Affiliation(s)
- Jiatong Ding
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yale Jiang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Jiang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shujun Xing
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fan Ge
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Peiwen Ma
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qiyu Tang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Huilei Miao
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiawei Zhou
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuan Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dandan Cui
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dongyan Liu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yanjie Han
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Weijie Yu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuning Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guo Zhao
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuanting Cai
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuhang Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Nan Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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11
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Gille R, Pérol M. [First line treatment of non-oncogene-addicted metastatic non-small cell lung cancer]. Bull Cancer 2025; 112:3S64-3S74. [PMID: 40155079 DOI: 10.1016/s0007-4551(25)00159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
Abstract
Since 2017, anti-PD-(L)1 immunotherapy has been the cornerstone of first-line treatment for stage IV non-oncogene-addicted non-small cell lung cancer. Its phase I development has established that the level of PD-L1 expression by tumor cells is predictive of response rate and progression-free survival. Above 50%, it makes chemotherapy not mandatory, with a median survival for pembrolizumab monotherapy of around 26 months and five-year survival of 32%. Large phase III studies have also validated the combination of anti-PD-(L)1 immunotherapy and platinum-based chemotherapy regardless of PD-L1 level of expression, increasing five-year survival from 10% to 18%. Dual immunotherapy combining anti-CTLA-4 and anti-PD-(L)1 might be interesting, especially in PD-L1 negative tumors, but is not available in France. Treatment personalization, particularly in the case of PD-L 1 expression >50%, should be based on response and non-response factors to immunotherapy, including patient-related factors such as performans status, age, smoking status, as well as tumor-related factors such as disease aggressiveness, tumor volume, mutational profile, along with concomitant medications. The optimal duration of immunotherapy is uncertain and arbitrarily set at two years. Many options are currently being explored to improve first-line treatment outcomes, as the majority of patients experience resistance to immunotherapy.
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Affiliation(s)
- Romane Gille
- Centre Léon-Bérard, 28 rue Laennec, 69008 Lyon, France.
| | - Maurice Pérol
- Centre Léon-Bérard, 28 rue Laennec, 69008 Lyon, France
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12
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Luo T, Chen W, Huang D, Liu X, Xi J, Fu Z, Chen J, Du Y, Cai R, Yu Q, Liu D, Du J, Liu L, Cai S, Dong H. Preclinical models of immune checkpoint inhibitors-related interstitial pneumonia for anti-PD1 tumor immunotherapy. Immunobiology 2025; 230:152884. [PMID: 39985972 DOI: 10.1016/j.imbio.2025.152884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 02/11/2025] [Accepted: 02/13/2025] [Indexed: 02/24/2025]
Abstract
Immune-related adverse reactions (irAEs) are common adverse reactions after immune checkpoint inhibitor treatment, impacting the universality and continued use of immunotherapy. Currently, preclinical models to investigate the mechanisms underlying these adverse effects are inadequate. This study aims to develop both in vitro and in vivo models of irAEs to advance basic research on these adverse reactions. For vitro models, we designed two co-culture systems: "Lung epithelial cells-PBMC" conditional co-culture model and "organoid-PBMCs" co-culture model. These involve culturing spheroids, patient-derived organoids and isolating, expanding, and co-culturing peripheral blood mononuclear cells (PBMCs). For vivo model, PD1 humanized mice were used to establish a lung carcinoma in situ model in offspring, with blocked immune checkpoints to induce systemic inflammatory responses. Mice without PD-1 blockade served as the control group. In both organoid and "lung epithelial cell-PBMC" models, compared with the control group, the PBMC+anti-PD1 group exhibited inflammatory injury, demonstrated by the worst activity, increased collagen deposition, elevated mRNA levels of αSMA and Vimentin, higher Fibronectin expression, and higher inflammatory factors (IL6, IL1β, MPO) in the culture supernatant (p < 0.05). In vivo model also showed pulmonary inflammation, with slower weight gain of the affected mice, more obvious pulmonary interstitial thickening(Masson staining and α-SMA immunofluorescence staining), and increased immune cells and IL17A in alveolar lavage fluid and serum. This study successfully developed preclinical models of irAEs using organoid technology, conditioned co-culture and humanized mouse models, effectively reproducing inflammatory injury and offering valuable tools for irAE research.
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Affiliation(s)
- Tingyue Luo
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weisheng Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Danhui Huang
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiguang Liu
- Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Junjie Xi
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zeyu Fu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Junwei Chen
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuhan Du
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ruijun Cai
- Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qi Yu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dongyu Liu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiangzhou Du
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Laiyu Liu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Shaoxi Cai
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Hangming Dong
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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13
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Lu R, Wang Z, Tian W, Shi W, Chu X, Zhou R. A retrospective study of radiotherapy combined with immunotherapy for patients with baseline brain metastases from non-small cell lung cancer. Sci Rep 2025; 15:7036. [PMID: 40016281 PMCID: PMC11868486 DOI: 10.1038/s41598-025-91863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 02/24/2025] [Indexed: 03/01/2025] Open
Abstract
This multi-center retrospective study aimed to evaluate the safety and efficacy of first-line immunotherapy in non-small-cell lung cancer (NSCLC) patients with brain metastases (BM). The study included 138 patients treated with immune checkpoint inhibitors (ICIs), either alone or in combination with brain radiotherapy (BRT), from 2020 to October 2023. Intracranial overall response rate (iORR), overall response rate (ORR), progression-free survival (PFS), intracranial progression-free survival (iPFS), overall survival (OS) and treatment-related toxicities were evaluated. Although patients receiving ICIs plus BRT showed a trend toward longer OS compared with ICI alone, the difference was not statistically significant (P = 0.201). Among 82 patients with available data, the iORR was 49.1% (35-63) in the ICIs alone group, and 75.9% (56-90) in the ICIs + BRT group. Notably, in patients requiring corticosteroids or mannitol, combination therapy was associated with a better prognosis (P = 0.05). We found that the iORR of patients treated with ICIs + BRT was improved and did not increase the incidence of serious adverse events (SAEs). Besides, the combination of ICIs and BRT improved the survival rate of subgroups of patients using corticosteroids.
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Affiliation(s)
- Ruoyu Lu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqi Wang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Wentao Tian
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Wen Shi
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Xianjing Chu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
| | - Rongrong Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
- Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, People's Republic of China.
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14
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Delbari P, Ahmadvand MH, Mirjani MS, Hajikarimloo B, Hamidi Rad R, Kargar-Soleimanabad S, Edalat M, Bahri A, Shahir Eftekhar M, Mohammadzadeh I, Habibi MA. The safety and efficacy of anti-PD-1/PD-L1 monoclonal antibodies for lung cancer brain metastasis: a systematic review and meta-analysis on brain metastasis. Neurosurg Rev 2025; 48:253. [PMID: 39969599 DOI: 10.1007/s10143-025-03418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 02/20/2025]
Abstract
Individuals with non-small cell lung cancer (NSCLC) who develop brain metastases face a poor prognosis and limited treatment options. Programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab and nivolumab, have emerged as a promising immunotherapy for treating lung cancer with brain metastases. This systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and evaluate the safety and efficacy of anti-PD-1/PD-L1 monoclonal antibodies in treating lung cancer patients with brain metastases. A comprehensive literature search was conducted to identify relevant studies up to 27 August 2023. Data on overall survival (OS), progression-free survival, radiological response rates, and adverse events were extracted. All statistical analysis was performed using STATA v.17. Our literature search yielded 39 eligible studies involving 15,428 patients. The overall response rate for PD-1 inhibitors was substantial, with pooled rates of 39% for overall response, 7% for complete response (CR), 27% for partial response (PR), and 31% for stable disease (SD). The pooled 6-month OS rate was 77%, and the 1-year OS rate was 61%. Subgroup analyses revealed higher PD-L1 expression levels and the use of platinum-based chemotherapy alongside immunotherapy were associated with improved outcomes. PD-1/PD-L1 inhibitors have demonstrated promising efficacy and safety in treating lung cancer patients with brain metastases, as evidenced by significant improvements in OS, PFS, and response rates. Incorporating PD-1/PD-L1 inhibitors into the treatment regimen, particularly for patients with high PD-L1 expression, has the potential to improve clinical outcomes in this patient population.
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Affiliation(s)
- Pouria Delbari
- Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran
| | | | | | - Bardia Hajikarimloo
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
| | - Romina Hamidi Rad
- Department of medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | - Mehrshad Edalat
- Department of medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Amirmohammad Bahri
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahir Eftekhar
- Department of Surgery, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Ibrahim Mohammadzadeh
- Skull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Patel L, Kolundzic N, Abedalthagafi M. Progress in personalized immunotherapy for patients with brain metastasis. NPJ Precis Oncol 2025; 9:31. [PMID: 39880875 PMCID: PMC11779815 DOI: 10.1038/s41698-025-00812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 01/20/2025] [Indexed: 01/31/2025] Open
Abstract
Brain metastasis leads to poor outcomes and CNS injury, significantly reducing quality of life and survival rates. Advances in understanding the tumor immune microenvironment have revealed the promise of immunotherapies, which, alongside surgery, chemotherapy, and radiation, offer improved survival for some patients. However, resistance to immunotherapy remains a critical challenge. This review explores the immune landscape of brain metastases, current therapies, clinical trials, and the need for personalized, biomarker-driven approaches to optimize outcomes.
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Affiliation(s)
- Lalit Patel
- Department of Pathology and Lab Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikola Kolundzic
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
- REPROCELL Europe Ltd., Glasgow, UK
| | - Malak Abedalthagafi
- Department of Pathology and Lab Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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16
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Xu Y, Chen K, Xu Y, Li H, Huang Z, Lu H, Huang D, Yu S, Han N, Gong L, Qin J, Chen J, Xie F, Hong W, Lin X, Cheng F, Luo X, Fan Y. Brain radiotherapy combined with camrelizumab and platinum-doublet chemotherapy for previously untreated advanced non-small-cell lung cancer with brain metastases (C-Brain): a multicentre, single-arm, phase 2 trial. Lancet Oncol 2025; 26:74-84. [PMID: 39756446 DOI: 10.1016/s1470-2045(24)00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 10/25/2024] [Accepted: 10/31/2024] [Indexed: 01/07/2025]
Abstract
BACKGROUND Brain metastases are a common complication in patients with non-small-cell lung cancer (NSCLC) lacking actionable driver mutations, with limited treatment options and poor prognosis. We aimed to investigate the efficacy and safety of brain radiotherapy combined with camrelizumab and platinum-doublet chemotherapy in patients with newly diagnosed advanced NSCLC and brain metastases. METHODS This multicentre, single-arm, phase 2 trial was done across nine tertiary hospitals in China. Eligible patients were aged 18 years or older, had newly diagnosed brain metastases from NSCLC with no actionable driver mutations (EGFR, ALK, or ROS1), and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Eligible patients were treated with stereotactic radiosurgery or whole-brain radiotherapy combined with camrelizumab (200 mg intravenously once every 3 weeks) and investigator-selected platinum-doublet chemotherapy (pemetrexed 500 mg/m2 plus platinum [carboplatin, area under curve (AUC) of 5, or cis-platinum 75 mg/m2] for non-squamous NSCLC, and nab-paclitaxel 260 mg/m2 plus platinum [carboplatin AUC 5, or cis-platinum 75 mg/m2] for squamous NSCLC) for four to six cycles. Patients with controlled disease then received maintenance treatment with camrelizumab alone (200 mg intravenously once every 3 weeks; for squamous NSCLC) or camrelizumab plus pemetrexed (500 mg/m2 every 3 weeks; for non-squamous NSCLC). The primary endpoint was 6-month progression-free survival rate in the full analysis set, which included all patients who received at least one dose of study treatment regardless of whether they had measurable brain lesions per RECIST 1.1. The trial was registered with ClinicalTrials.gov, NCT04291092, and is ongoing. FINDINGS Between May 6, 2020, and Jan 30, 2023, 67 patients were assessed for eligibility. Two patients were excluded (brain lesions less than 5 mm) and 65 patients were enrolled and treated. Median age was 66 years (IQR 62-70). 60 (92%) of 65 patients were male and five (8%) were female. All 65 patients were Han Chinese. 50 (77%) of 65 patients had non-squamous NSCLC and 46 (71%) were symptomatic. The 6-month progression-free survival rate was 71·7% (95% CI 58·9-81·1) during the median follow-up of 14·1 months (IQR 9·0-20·3; data cutoff Dec 13, 2023). The most common grade 3-4 treatment-related adverse events were decreased neutrophil count (14 [22%] of 65 patients), decreased white blood cell count (ten [15%]), decreased platelet count (ten [15%]), and decreased lymphocyte count (nine [14%]). Neurological toxic effects of grade 3 occurred in three (5%) of 65 patients. Radiation necrosis occurred in three (5%) of 65 patients; all were grade 1 or 2. There were no treatment-related deaths. INTERPRETATION Brain radiotherapy combined with camrelizumab and platinum-doublet chemotherapy shows promising efficacy and manageable toxicity and could be a potential treatment option for patients with brain metastases from NSCLC. Randomised controlled trials will be required to confirm these findings. FUNDING Beijing Xisike Clinical Oncology Research Foundation and Jiangsu Hengrui Pharmaceuticals. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yanjun Xu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Kaiyan Chen
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Yujin Xu
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Hui Li
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Zhiyu Huang
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Hongyang Lu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Dingzhi Huang
- Department of Thoracic Medical Oncology, Lung Cancer Diagnosis and Treatment Centre, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Tianjin, China
| | - Sizhe Yu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Na Han
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Lei Gong
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Jing Qin
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Jun Chen
- Department of Chemoradiotherapy, the Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Fajun Xie
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Wei Hong
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Xiao Lin
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Fengzhuo Cheng
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Xiaojie Luo
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Yun Fan
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China.
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Brown LJ, Yeo N, Gee H, Kong BY, Hau E, da Silva IP, Nagrial A. Immune Checkpoint Inhibitors +/- Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta-Analysis. Thorac Cancer 2025; 16:e15510. [PMID: 39843204 PMCID: PMC11753865 DOI: 10.1111/1759-7714.15510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/15/2024] [Accepted: 11/27/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Multiple studies have demonstrated the intracranial efficacy of immune checkpoint inhibitors (ICI) +/- chemotherapy. The efficacy of chemoimmunotherapy compared to ICI alone in patients with metastatic NSCLC and brain metastases (BM) remains unknown. METHODS A systematic review and network meta-analysis were performed to evaluate ICI efficacy and the influence of additional chemotherapy on survival outcomes in treatment-naïve metastatic NSCLC with BM. Randomized phase II/III studies with at least one treatment arm with an ICI were eligible. Overall survival (OS) and progression-free survival (PFS) in patients with and without BM were assessed. RESULTS Ten studies were included, totaling 6560 patients, 770 with BM. Pairwise meta-analysis revealed that patients with BM treated with ICI +/- chemotherapy had improved PFS (hazard ratio [HR] 0.49; 95% CI 0.40-0.60) and OS (HR 0.55; 95% CI 0.44-0.68) versus chemotherapy alone. Patients without BM treated with ICI +/- chemotherapy also had improved PFS and OS compared to chemotherapy alone. In the network meta-analysis of patients with BM, chemoimmunotherapy demonstrated improved PFS compared to ICI alone (HR 0.64; 95% CI 0.43-0.96; p = 0.03). No significant difference was observed in OS. In the population of patients without BM, no significant differences in PFS or OS were observed between chemoimmunotherapy versus ICI alone. CONCLUSION This meta-analysis confirms that ICIs with or without chemotherapy are superior to chemotherapy alone for the first-line management of metastatic NSCLC with and without BM. This network meta-analysis suggests combination chemoimmunotherapy offers PFS benefit over ICI monotherapy in BM patients, warranting direct comparisons in clinical trials. TRIAL REGISTRATION PROSPERO: CRD42024501345.
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Affiliation(s)
- Lauren Julia Brown
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
- Blacktown Cancer and Haematology CentreBlacktown HospitalSydneyNew South WalesAustralia
- Translational Radiation Biology and Oncology GroupWestmead Institute for Medical ResearchWestmeadNew South WalesAustralia
| | - Nicholas Yeo
- Department of Medical OncologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Harriet Gee
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
- Blacktown Cancer and Haematology CentreBlacktown HospitalSydneyNew South WalesAustralia
- Translational Radiation Biology and Oncology GroupWestmead Institute for Medical ResearchWestmeadNew South WalesAustralia
- Children's Medical Research InstituteWestmeadNew South WalesAustralia
| | - Benjamin Y. Kong
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Department of Medical OncologyPrince of Wales HospitalRandwickNew South WalesAustralia
- SPHERE Cancer Clinical Academic Group, Faculty of MedicineUniversity of NSWSydneyNew South WalesAustralia
| | - Eric Hau
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
- Blacktown Cancer and Haematology CentreBlacktown HospitalSydneyNew South WalesAustralia
- Translational Radiation Biology and Oncology GroupWestmead Institute for Medical ResearchWestmeadNew South WalesAustralia
| | - Inês Pires da Silva
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
- Blacktown Cancer and Haematology CentreBlacktown HospitalSydneyNew South WalesAustralia
- Melanoma Institute AustraliaWollstonecraftNew South WalesAustralia
| | - Adnan Nagrial
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
- Blacktown Cancer and Haematology CentreBlacktown HospitalSydneyNew South WalesAustralia
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18
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Abdallah M, Voland R, Decamp M, Flickinger J, Pacioles T, Jamil M, Silbermins D, Shenouda M, Valsecchi M, Bir A, Shweihat Y, Bastidas J, Chowdhury N, Kachynski Y, Eldib H, Wright T, Mahdi A, Al-Nusair J, Nwanwene K, Varlotto J. Evaluation of Anti-Angiogenic Therapy Combined with Immunotherapy and Chemotherapy as a Strategy to Treat Locally Advanced and Metastatic Non-Small-Cell Lung Cancer. Cancers (Basel) 2024; 16:4207. [PMID: 39766108 PMCID: PMC11674749 DOI: 10.3390/cancers16244207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 11/23/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025] Open
Abstract
Immunotherapy has made recent improvements in disease-free survival (DFS) and/or overall survival (OS) in all stages of non-small-cell lung cancer (NSCLC). Here, we review the tumor microenvironment and its immunosuppressive effects and discuss how anti-angiogenic therapies may potentiate the anti-carcinogenic effects of immunotherapy. We also review all the past literature and discuss strategies of combining anti-angiogenic therapy and immunotherapy +/- chemotherapy and hypothesize how we can use this strategy for non-small-cell lung cancer in metastatic previously untreated/previously treated settings in previously treated EGFR-mutated NSCLC for the upfront treatment of brain metastases prior to radiation therapy and for the incorporation of this strategy into stage III unresectable disease. We assert the use of anti-angiogenic therapy and immunotherapy when combined appropriately with chemotherapy and radiotherapy has the potential to increase the long-term survivals in both the stage III and metastatic setting so that we can now consider more patients to experience curative treatment.
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Affiliation(s)
- Mahmoud Abdallah
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Rick Voland
- Department of Ophthalmology, University of Wisconsin, Madison, WI 53705, USA;
| | - Malcolm Decamp
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA;
| | - Toni Pacioles
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Muhammad Jamil
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Damian Silbermins
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Mina Shenouda
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Matias Valsecchi
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Arvinder Bir
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Yousef Shweihat
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Juan Bastidas
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Nepal Chowdhury
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Yury Kachynski
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Howide Eldib
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - Thomas Wright
- Department of Internal Medicine, Marshall Health, Huntington, WV 25701, USA; (T.W.); (A.M.); (J.A.-N.)
| | - Ahmad Mahdi
- Department of Internal Medicine, Marshall Health, Huntington, WV 25701, USA; (T.W.); (A.M.); (J.A.-N.)
| | - Jowan Al-Nusair
- Department of Internal Medicine, Marshall Health, Huntington, WV 25701, USA; (T.W.); (A.M.); (J.A.-N.)
| | - Kemnasom Nwanwene
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
| | - John Varlotto
- Department of Oncology, Edwards Comprehensive Cancer Institute, Marshall University, Huntington, WV 25701, USA; (M.A.); (T.P.); (M.J.); (D.S.); (M.S.); (M.V.); (A.B.); (Y.S.); (J.B.); (N.C.); (Y.K.); (H.E.); (K.N.)
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19
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Wang S, Uriel M, Cheng H. Lung Cancer with Brain Metastasis-Treatment Strategies and Molecular Characteristics. J Clin Med 2024; 13:7371. [PMID: 39685828 DOI: 10.3390/jcm13237371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/18/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Lung cancer is a leading cause of brain metastases (BMs), with 10-20% of patients with non-small cell lung cancer (NSCLC) presenting with BMs at diagnosis and 25-50% developing them over the course of their disease. Historically, BMs have posed significant therapeutic challenges, partly due to the blood brain barrier (BBB), which restricts drug penetration to the central nervous system. Consequently, BMs were initially managed with local treatments, including surgical resection, stereotactic radiosurgery, and whole brain radiation therapy. In recent years, however, systemic treatments for BMs have advanced significantly, particularly with the development of molecularly-targeted therapies and immunotherapies. The discovery of driver mutations and the development of novel tyrosine kinase inhibitors (TKIs) have yielded encouraging intracranial responses in NSCLC patients with actionable genetic alterations (e.g., EGFR, ALK, ROS1). Genomic profiling has also suggested genetic heterogeneity between BMs and primary sites. Immunotherapies, alone or in combination with other treatments, have demonstrated promising results in NSCLC with BMs, although most clinical trials have included only selected patients with asymptomatic or previously treated BMs. In this review, we discuss the molecular and immune characteristics of NSCLC with BMs, analyze intracranial efficacy findings from clinical trials, and explore treatment strategies for lung cancer patients with BMs.
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Affiliation(s)
- Shuai Wang
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
| | - Matan Uriel
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
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20
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Masuda T, Tsubata Y, Hata K, Horie M, Kiura K, Kanaji N, Inoue T, Kodani M, Yanai M, Yamaguchi K, Matsumoto N, Yamasaki M, Ishikawa N, Masuda K, Takigawa N, Kuyama S, Kubota T, Nishii K, Hotta K, Hattori N. Efficacy of immune checkpoint inhibitors according to programmed cell death-ligand 1 expression in patients with non-small cell lung cancer and brain metastasis: A real-world prospective observational study. Thorac Cancer 2024; 15:2408-2417. [PMID: 39415454 PMCID: PMC11609048 DOI: 10.1111/1759-7714.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/08/2024] [Accepted: 09/29/2024] [Indexed: 10/18/2024] Open
Abstract
INTRODUCTION Studies have shown the antitumor efficacy of immune checkpoint inhibitors (ICI) in patients with non-small cell lung cancer (NSCLC) and brain metastases (BM). However, it is unclear whether the efficacy of ICI is similar between patients with and without BM. It is yet unclear whether the efficacy of ICI in patients with BM increases with higher levels of programmed cell death-ligand 1 (PD-L1) expression, as observed in patients without BM. METHODS We compared the outcomes of ICI treatment between patients with and without BM using a cohort containing 1741 prospectively enrolled patients with lung cancer. We investigated whether there were differences in the outcomes of ICI based on PD-L1 expression levels between these patients. RESULTS We enrolled 240 patients with NSCLC with or without BM who were treated with ICI or both chemotherapy and ICI. There were no significant differences in overall survival (OS) between all patients with or without BM (p = 0.489). However, OS was significantly shorter in patients with BM than in those without in the PD-L1 ≥ 50% group (16.5 M vs. 30.6 M, p = 0.003) but not in the PD-L1 ≥ 1% or negative group. BM was an independent poor prognostic factor for OS (hazard ratio: [95% confidence interval], 2.045; [1.058-3.953], p = 0.033) in the PD-L1 ≥ 50% group. CONCLUSION Our study indicated that the outcomes of patients with or without BM treated with ICI were not significantly different. The efficacy of ICI in patients with PD-L1 expression ≥50% would be lower in patients with BM than in those without.
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Affiliation(s)
- Takeshi Masuda
- Department of Respiratory MedicineHiroshima University HospitalHiroshimaJapan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Faculty of MedicineShimane UniversityIzumoJapan
| | - Kojirou Hata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Faculty of MedicineShimane UniversityIzumoJapan
| | - Mika Horie
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Faculty of MedicineShimane UniversityIzumoJapan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory MedicineOkayama University HospitalOkayamaJapan
| | - Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of MedicineKagawa UniversityKita‐gunJapan
| | - Takuya Inoue
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of MedicineKagawa UniversityKita‐gunJapan
| | - Masahiro Kodani
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of MedicineTottori UniversityYonagoJapan
| | - Masaaki Yanai
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of MedicineTottori UniversityYonagoJapan
| | - Kakuhiro Yamaguchi
- Department of Respiratory MedicineHiroshima University HospitalHiroshimaJapan
| | - Naoko Matsumoto
- Department of Respiratory MedicineHiroshima Red Cross Hospital and Atomic‐Bomb Survivors HospitalHiroshimaJapan
| | - Masahiro Yamasaki
- Department of Respiratory MedicineHiroshima Red Cross Hospital and Atomic‐Bomb Survivors HospitalHiroshimaJapan
| | - Nobuhisa Ishikawa
- Department of Respiratory MedicineHiroshima Prefectural HospitalHiroshimaJapan
| | - Ken Masuda
- Department of Respiratory MedicineHiroshima Prefectural HospitalHiroshimaJapan
| | - Nagio Takigawa
- General Internal Medicine 4Kawasaki Medical SchoolOkayamaJapan
| | - Shoichi Kuyama
- Department of Respiratory MedicineNational Hospital Organization Iwakuni Clinical CenterYamaguchiJapan
| | - Tetsuya Kubota
- Department of Respiratory Medicine and AllergologyKochi University HospitalNankokuJapan
| | - Kazuya Nishii
- Department of Respiratory MedicineNational Hospital Organization Iwakuni Clinical CenterYamaguchiJapan
| | - Katsuyuki Hotta
- Center for Innovative Clinical MedicineOkayama University HospitalOkayamaJapan
| | - Noboru Hattori
- Department of Respiratory MedicineHiroshima University HospitalHiroshimaJapan
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21
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Colonese F, Bulotta A, Genova C, Signorelli D, Bonanno L, Proto C, Immunotherapy in NSCLC Delphi Panel, Cortinovis DL. Immunotherapy in Non-Small-Cell Lung Cancer: A Modified Delphi Survey Consensus on First Line Treatment, Special Populations and Rechallenge. Biomedicines 2024; 12:2742. [PMID: 39767647 PMCID: PMC11727585 DOI: 10.3390/biomedicines12122742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/14/2024] [Accepted: 11/20/2024] [Indexed: 01/16/2025] Open
Abstract
Background: The treatment landscape for non-small cell lung cancer (NSCLC) has evolved significantly with the advent of immunotherapy. Nonetheless, uncertainty regarding optimal first-line treatments, special populations, and the feasibility of rechallenge remains. This study aims to investigate Italian oncologists' opinions on these aspects through a Delphi Survey. Methods: A steering committee (SC) of six oncologists identified three topics of interest, namely NSCLC (first line) therapeutic choice, NSCLC special populations, and NSCLC immunotherapy rechallenge), and drafted several topic-related statements to be voted in the Delphi Survey by the 61 oncologists forming the Delphi Panel. The survey included two rounds, wherein the experts rated their agreement/disagreement with the statements on a 5-point Likert scale. Consensus was defined as agreement/disagreement by at least 75% of the panel. Results: The SC drafted 69 statements for the first round, of which 16 (23.2%) met the agreement threshold, 5 (7.2%) met the disagreement threshold, and 48 (69.6%) did not reach consensus. The SC revised the latter statements and drafted 37 for the second round. Overall, 5 (13.5%) statements met the agreement threshold, 1 (2.7%) met the disagreement threshold, and 31 (83.8%) did not reach consensus in the second round. Conclusions: The survey showed agreement on the necessity of molecular characterization, mutations, smoke, the role of steroid therapy, and immunotherapy rechallenge, and revealed several areas of uncertainty among Italian oncologists on the use of immunotherapy in NSCLC. Statements-where consensus was not met-can be used to guide future clinical research in resolving the issues.
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Affiliation(s)
- Francesca Colonese
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori di Monza, 20900 Monza, Italy;
| | - Alessandra Bulotta
- Department of Oncology, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy;
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties, University of Genoa, 16132 Genoa, Italy;
- Academic Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Diego Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Laura Bonanno
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35131 Padova, Italy;
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | | | - Diego Luigi Cortinovis
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori di Monza, 20900 Monza, Italy;
- Department of Medicine, University of Milano-Bicocca, 20126 Monza, Italy
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22
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Podder V, Ranjan T, Margolin K, Maharaj A, Ahluwalia MS. Evaluating the Safety of Immune Checkpoint Inhibitors and Combination Therapies in the Management of Brain Metastases: A Comprehensive Review. Cancers (Basel) 2024; 16:3929. [PMID: 39682118 DOI: 10.3390/cancers16233929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 10/31/2024] [Accepted: 11/21/2024] [Indexed: 12/18/2024] Open
Abstract
Brain metastases (BM) are a frequent and severe complication in patients with lung cancer, breast cancer, and melanoma. Immune checkpoint inhibitors (ICIs) have become a crucial treatment option for BM, whether used alone or in combination with chemotherapy and stereotactic radiosurgery (SRS). However, ICIs are associated with immune-related adverse events (irAEs) that can affect multiple organ systems, complicating their use in BM patients. This review examines the mechanisms of irAEs and their effects on different organs and evaluates the safety of ICIs across various treatment strategies for BM. Our analysis indicates that ICIs significantly improve survival and disease control in BM patients, but their use increases the risk of irAEs, including dermatologic, gastrointestinal, endocrine, pulmonary, and neurologic toxicities. Neurotoxic events, particularly treatment-associated brain necrosis (TABN) and encephalitis, are more common in BM patients. While the overall incidence of irAEs is similar between patients with and without BM, the neurotoxicity risk is higher in the BM population. Combining ICIs with chemotherapy and SRS enhances efficacy but also heightens the risk of adverse events across organ systems. ICIs offer substantial benefits for BM patients but require careful management to mitigate the risks of irAEs. Close patient monitoring, individualized treatment protocols, and prompt intervention are essential for optimizing the outcomes. Future research should focus on refining combination strategies and improving the management of irAEs, particularly neurotoxicity, to maximize therapeutic benefits for BM patients.
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Affiliation(s)
- Vivek Podder
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA
| | - Tulika Ranjan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA
| | - Kim Margolin
- Saint John's Cancer Institute, Santa Monica, CA 90404, USA
| | - Arun Maharaj
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA
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Tsuchiya-Kawano Y, Shiraishi Y, Tanaka K, Tachihara M, Saito R, Okamoto T, Sugasaki N, Nakatomi K, Kiyomi F, Okamoto I. Nivolumab plus ipilimumab with chemotherapy for non-small cell lung cancer with untreated brain metastases: A multicenter single-arm phase 2 trial (NIke, LOGiK 2004). Eur J Cancer 2024; 212:115052. [PMID: 39357279 DOI: 10.1016/j.ejca.2024.115052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/04/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The effect of dual immunotherapy combined with platinum-based chemotherapy on untreated brain metastases derived from non-small cell lung cancer (NSCLC) has remained unclear. METHODS This multicenter single-arm phase 2 study enrolled patients with chemotherapy-naïve advanced NSCLC and at least one brain metastasis ≥ 5 mm in size that had not been previously treated. Patients received nivolumab plus ipilimumab combined with platinum-doublet chemotherapy (two cycles), followed by nivolumab-ipilimumab alone. The primary endpoint of the study was intracranial response rate as determined by modified Response Evaluation Criteria in Solid Tumors (RECIST) for brain metastases of ≥ 5 mm as target lesions. RESULTS A total of 30 patients from 18 institutions was enrolled in this study. The median age was 66.5 years (range, 47-83 years), and 26 patients (87 %) had a non-squamous cell carcinoma histology. The median size of all target brain lesions was 8.4 mm, with a range of 5-39 mm. The intracranial response rate assessed by modified RECIST was 50.0 % (95 % CI, 33.2-66.8 %), with the rate of complete response being 20.0 %, and the study met its primary endpoint. The systemic response rate was 53.3 % (95 % CI, 36.1-69.8 %), and responses for intracranial and extracranial lesions were generally consistent. The median intracranial progression-free survival was 8.1 months, and both the median intracranial duration of response and time to brain radiotherapy were not reached. CONCLUSION Nivolumab plus ipilimumab combined with platinum-based chemotherapy showed promising intracranial activity in NSCLC patients with untreated brain metastases. TRIAL REGISTRATION jRCT071210019.
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Affiliation(s)
- Yuko Tsuchiya-Kawano
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka 802-0077, Japan
| | - Yoshimasa Shiraishi
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kentaro Tanaka
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan
| | - Nanae Sugasaki
- Department of Respiratory Medicine, Nagasaki Prefecture Shimabara Hospital, 7895 Shimokawashiri-machi, Shimabara, Nagasaki 855-0861, Japan
| | - Keita Nakatomi
- Department of Respiratory Medicine, Kyushu Central Hospital, 3-23-1 Shiobaru, Minami-ku, Fukuoka 815-0032, Japan
| | - Fumiaki Kiyomi
- Clinical Research Support Center Kyushu, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Reck M, Ciuleanu TE, Schenker M, Bordenave S, Cobo M, Juan-Vidal O, Reinmuth N, Richardet E, Felip E, Menezes J, Cheng Y, Mizutani H, Zurawski B, Alexandru A, Carbone DP, Lu S, John T, Aoyama T, Grootendorst DJ, Hu N, Eccles LJ, Paz-Ares LG. Five-year outcomes with first-line nivolumab plus ipilimumab with 2 cycles of chemotherapy versus 4 cycles of chemotherapy alone in patients with metastatic non-small cell lung cancer in the randomized CheckMate 9LA trial. Eur J Cancer 2024; 211:114296. [PMID: 39270380 DOI: 10.1016/j.ejca.2024.114296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND We report 5-year efficacy and safety outcomes from CheckMate 9LA in patients with metastatic non-small cell lung cancer (mNSCLC) and exploratory analyses in key patient subgroups. METHODS Adults with stage IV/recurrent NSCLC and no sensitizing EGFR/ALK alterations were randomized to receive nivolumab plus ipilimumab with chemotherapy (n = 361) or chemotherapy (n = 358). Outcomes were assessed in all randomized patients and subgroups. RESULTS With 57.3 months' minimum follow-up, patients continued to derive overall survival (OS) benefit with nivolumab plus ipilimumab with chemotherapy over chemotherapy (HR, 0.73; 95% CI, 0.62-0.85; 5-year OS rates, 18% vs. 11%), regardless of tumor programmed death ligand 1 (PD-L1) expression (PD-L1 < 1%, 22% vs. 8%; PD-L1 ≥ 1%, 18% vs. 11%), histology (squamous, 18% vs. 7%; non-squamous, 19% vs. 12%), or presence of baseline brain metastases (20% vs. 6%). Five-year duration of response (DOR) rates were 19% versus 8% with nivolumab plus ipilimumab with chemotherapy versus chemotherapy, with consistent benefit across subgroups. Patients who discontinued nivolumab plus ipilimumab with chemotherapy due to treatment-related adverse events had a 5-year OS rate of 37%. Five-year progression-free survival and DOR rates in 5-year survivors were 55% versus 38% and 59% versus 46%, respectively. No new safety signals were observed in 5-year survivors, regardless of the number of ipilimumab doses received. CONCLUSION This 5-year update supports the long-term, durable OS benefit and improved 5-year survivorship with nivolumab plus ipilimumab with chemotherapy over chemotherapy in patients with mNSCLC, regardless of tumor PD-L1 expression or histology. CLINICALTRIALS GOV REGISTRATION NCT03215706.
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Affiliation(s)
- Martin Reck
- Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany.
| | - Tudor-Eliade Ciuleanu
- Institutul Oncologic Prof Dr Ion Chiricuţă and University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | | | | | - Manuel Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research, Munich-Gauting, Germany
| | | | - Enriqueta Felip
- Medical Oncology Service, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Ying Cheng
- Jilin Cancer Hospital, Changchun, Jilin, China
| | | | - Bogdan Zurawski
- Chemotherapy Department, Ambulatorium Chemioterapii, Bydgoszcz, Poland
| | - Aurelia Alexandru
- Department of Oncology, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania
| | - David P Carbone
- The Ohio State University Comprehensive Cancer Center and the Pelotonia Institute for Immuno-Oncology, Columbus, OH, United States
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Thomas John
- Austin Hospital, Heidelberg, Victoria, Australia
| | | | | | - Nan Hu
- Bristol Myers Squibb, Princeton, NJ, United States
| | | | - Luis G Paz-Ares
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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25
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Ranjan T, Podder V, Margolin K, Velcheti V, Maharaj A, Ahluwalia MS. Immune Checkpoint Inhibitors in the Management of Brain Metastases from Non-Small Cell Lung Cancer: A Comprehensive Review of Current Trials, Guidelines and Future Directions. Cancers (Basel) 2024; 16:3388. [PMID: 39410008 PMCID: PMC11475580 DOI: 10.3390/cancers16193388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Brain metastases (BM) are a common, severe complication in patients with non-small cell lung cancer (NSCLC) and are difficult to treat due to their complex tumor biology and the intricate microenvironment of the brain. OBJECTIVES This review examines the current role of immune checkpoint inhibitors (ICIs) in treating NSCLC with BM, focusing on the latest clinical trials, emerging strategies, current guidelines, and future directions. We highlight the efficacy of ICIs as monotherapy and in combination with other treatments such as radiotherapy, stereotactic radiosurgery, chemotherapy, and anti-VEGF agents. RESULTS While no single treatment sequence is universally accepted, combining ICIs with traditional therapies forms the core of the current treatment protocols. ICIs targeting the PD-1/PD-L1 pathway have significantly advanced NSCLC treatment, demonstrated by improved overall and progression-free survival in various settings. However, optimizing these benefits requires careful consideration of potential side effects, including cognitive decline and radiation necrosis, and the impact of steroid use on ICI efficacy. CONCLUSION The review underscores the necessity for a personalized, integrated multidisciplinary treatment approach. Future research should focus on refining combination therapies and understanding the optimal sequence and timing of treatment.
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Affiliation(s)
- Tulika Ranjan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA; (T.R.); (V.P.); (A.M.)
| | - Vivek Podder
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA; (T.R.); (V.P.); (A.M.)
| | - Kim Margolin
- Saint John’s Cancer Institute, Santa Monica, CA 90404, USA;
| | | | - Arun Maharaj
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA; (T.R.); (V.P.); (A.M.)
| | - Manmeet Singh Ahluwalia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33186, USA; (T.R.); (V.P.); (A.M.)
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Reina C, Šabanović B, Lazzari C, Gregorc V, Heeschen C. Unlocking the future of cancer diagnosis - promises and challenges of ctDNA-based liquid biopsies in non-small cell lung cancer. Transl Res 2024; 272:41-53. [PMID: 38838851 DOI: 10.1016/j.trsl.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
The advent of liquid biopsies has brought significant changes to the diagnosis and monitoring of non-small cell lung cancer (NSCLC), presenting both promise and challenges. Molecularly targeted drugs, capable of enhancing survival rates, are now available to around a quarter of NSCLC patients. However, to ensure their effectiveness, precision diagnosis is essential. Circulating tumor DNA (ctDNA) analysis as the most advanced liquid biopsy modality to date offers a non-invasive method for tracking genomic changes in NSCLC. The potential of ctDNA is particularly rooted in its ability to furnish comprehensive (epi-)genetic insights into the tumor, thereby aiding personalized treatment strategies. One of the key advantages of ctDNA-based liquid biopsies in NSCLC is their ability to capture tumor heterogeneity. This capability ensures a more precise depiction of the tumor's (epi-)genomic landscape compared to conventional tissue biopsies. Consequently, it facilitates the identification of (epi-)genetic alterations, enabling informed treatment decisions, disease progression monitoring, and early detection of resistance-causing mutations for timely therapeutic interventions. Here we review the current state-of-the-art in ctDNA-based liquid biopsy technologies for NSCLC, exploring their potential to revolutionize clinical practice. Key advancements in ctDNA detection methods, including PCR-based assays, next-generation sequencing (NGS), and digital PCR (dPCR), are discussed, along with their respective strengths and limitations. Additionally, the clinical utility of ctDNA analysis in guiding treatment decisions, monitoring treatment response, detecting minimal residual disease, and identifying emerging resistance mechanisms is examined. Liquid biopsy analysis bears the potential of transforming NSCLC management by enabling non-invasive monitoring of Minimal Residual Disease and providing early indicators for response to targeted treatments including immunotherapy. Furthermore, considerations regarding sample collection, processing, and data interpretation are highlighted as crucial factors influencing the reliability and reproducibility of ctDNA-based assays. Addressing these challenges will be essential for the widespread adoption of ctDNA-based liquid biopsies in routine clinical practice, ultimately paving the way toward personalized medicine and improved outcomes for patients with NSCLC.
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Affiliation(s)
- Chiara Reina
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Berina Šabanović
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Chiara Lazzari
- Department of Medical Oncology, Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Vanesa Gregorc
- Department of Medical Oncology, Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Christopher Heeschen
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy;.
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27
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Okuno T, Isobe T, Tsubata Y. Current pharmacologic treatment of brain metastasis in non-small cell lung cancer. Clin Exp Metastasis 2024; 41:549-565. [PMID: 38466521 PMCID: PMC11499348 DOI: 10.1007/s10585-024-10276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
Lung cancer is a type of cancer that can metastasize to the lungs, brain, bones, liver, adrenal glands, and other organs; however, the occurrence of brain metastases is the most common event. Symptoms of brain metastasis include motor dysfunction, mental dysfunction, seizures, headaches, nausea, and vomiting, and significantly reduce the quality of life of cancer patients. Brain metastases are a poor prognostic factor, and controlling them is extremely important for prolonging prognosis and improving the quality of life. Currently, local surgery and radiotherapy are recommended for their treatment. However, recently, cancer treatments using molecular-targeted drugs and immune checkpoint inhibitors have been introduced, which may also be effective against brain metastases. Therefore, it is necessary to determine whether local or systemic therapy is optimal for each case. In this review, we focus on recent findings regarding drug therapy in treating brain metastases from advanced non-small cell lung cancer.
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Affiliation(s)
- Takae Okuno
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1, Enyacho, Izumo, Shimane, 693-8501, Japan
| | - Takeshi Isobe
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1, Enyacho, Izumo, Shimane, 693-8501, Japan
| | - Yukari Tsubata
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1, Enyacho, Izumo, Shimane, 693-8501, Japan.
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28
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Nigen B, Bodergat T, Vaugier L, Pons-Tostivint E. [First-line immunotherapy in non-small cell lung cancer diagnosed with brain metastases]. Rev Mal Respir 2024; 41:571-582. [PMID: 38926022 DOI: 10.1016/j.rmr.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Up to 30% patients newly diagnosed with advanced non-small cell lung cancer (NSCLC) present with brain metastases. In the absence of oncogenic addiction, first-line immunotherapy, alone or in combination with chemotherapy, is the current standard of care. This review aims to synthesize the available data regarding the efficacy of immunotherapy in these patients, and to discuss the possibility of its being coordinated with local treatments such as radiotherapy. STATE OF THE ART NSCLC patients with brain metastases appear to have survival benefits with immunotherapy similar to those of NSCLC patients without brain metastases. However, this finding is based on mainly prospective studies having included highly selected patients with pre-treated and stable brain metastases. Several retrospective studies and two prospective single-arm studies have confirmed the intracranial efficacy of immunotherapy, either alone or in combination with chemotherapy. PERSPECTIVES The indications and optimal timing for cerebral radiotherapy remain subjects of debate. To date, there exists no randomized study assessing the addition of brain radiotherapy to first-line immunotherapy. That said, a recent meta-analysis showed increased intracerebral response when radiotherapy complemented immunotherapy. CONCLUSIONS For NSCLC patients with brain metastases, the available data suggest a clear benefit of first-line immunotherapy, whether alone or combined with chemotherapy. However, most of these data are drawn from retrospective, non-randomized studies with small sample sizes.
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Affiliation(s)
- B Nigen
- Service de pneumologie, centre hospitalier Les Sables-d'Olonne, Les Sables-d'Olonne, France
| | - T Bodergat
- Oncologie médicale, centre hospitalier universitaire Nantes, Nantes université, Nantes, France
| | - L Vaugier
- Département de radiothérapie, institut de cancérologie de l'Ouest, Saint-Herblain, France
| | - E Pons-Tostivint
- Oncologie médicale, centre hospitalier universitaire Nantes, Nantes université, Nantes, France; Nantes université, Inserm UMR 1307, CNRS UMR 6075, université d'Angers, CRCI2NA, Nantes, France.
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Sumiyoshi K, Yatsushige H, Shigeta K, Aizawa Y, Fujino A, Ishijima N, Hayakawa T. Survival prognostic factors in nonsmall cell lung cancer patients with simultaneous brain metastases and poor performance status at initial presentation. Heliyon 2024; 10:e38128. [PMID: 39381209 PMCID: PMC11458999 DOI: 10.1016/j.heliyon.2024.e38128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 09/15/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024] Open
Abstract
Purpose Although the treatment of nonsmall cell lung cancer (NSCLC) has rapidly progressed recently, there is little evidence of treatment for patients with symptomatic brain metastases (BM) and poor performance status (PS). However, in symptomatic BM patients, appropriate upfront intracranial treatment can often lead to rapid improvement in PS and effective systemic therapy. Thus, this study investigated the prognostic factors for the survival of poor PS NSCLC patients with synchronous BM. Methods Data of patients with BM and Karnofsky PS (KPS) ≤70 at the first diagnosis of NSCLC who were treated in our hospital between January 2017 and December 2021 were reviewed. Patient survival was compared among patients stratified by type of first-line regimen of systemic treatment. Correlations between patient characteristics and survival were examined. Results Fifty patients receiving aggressive treatment were enrolled. The median survival times for tyrosine kinase inhibitor (TKI), immune checkpoint inhibitor (ICI), and chemotherapy alone groups were 19 (95 % confidence interval [CI], 2.8-68.5), 19 (3.0-62.0), and 13 (1.2-24.8) months, respectively. Survival in the TKI and ICI groups was significantly longer than in the chemotherapy alone group (p = 0.046, TKI vs. chemo; p = 0.022, ICI vs. chemo; p = 0.023). Both sex and type of systemic treatment correlated to survival time on univariate analysis. Chemotherapy alone for systemic treatment [p = 0.034; hazard ratio (HR), 0.44 (0.20-0.94)] remained significant for predicting overall survival in the multivariate analysis. Conclusion Even in patients with poor PS and BM at the initial diagnosis of NSCLC, the ICI group had a survival time comparable to that of the TKI group when combined with tailor-made intracranial treatment. There is a subgroup in the patient population that was previously considered unsuitable for ICI, whose PS improves with individualized intracranial treatment, and who may benefit from immunotherapy.
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Affiliation(s)
- Kyoko Sumiyoshi
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Hiroshi Yatsushige
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Keigo Shigeta
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Yuuki Aizawa
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Asuka Fujino
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Nozomi Ishijima
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
| | - Takanori Hayakawa
- Division of Neurosurgery, Division of Neurosurgery, National Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, Japan
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Meyers DE, Rittberg R, Dawe DE, Banerji S. Immunotherapy in Patients with Advanced Non-Small-Cell Lung Cancer Under-Represented by Clinical Trials. Curr Oncol 2024; 31:5498-5515. [PMID: 39330035 PMCID: PMC11431477 DOI: 10.3390/curroncol31090407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/08/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024] Open
Abstract
Since the initial US FDA approval of an immune checkpoint inhibitor (ICI) for the treatment of non-oncogene-driven non-small-cell lung cancer (NSCLC) nine years ago, this therapeutic strategy has been cemented as a crucial component of treatment for most of these patients. However, there is a clear efficacy-effectiveness gap whereby patients in the 'real world' seem to have more modest clinical outcomes compared to those enrolled in landmark clinical trials. This gap may be driven by the under-representation of important patient populations, including populations defined by clinical or molecular characteristics. In this review, we summarize the data outlining the evidence of ICIs in patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS), underlying autoimmune disease (AID), older age, active brain metastases (BMs), and molecular aberrations such as EGFR mutations, ALK fusions, BRAF mutations and ROS1 fusions.
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31
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Pușcașu A, Moinard-Butot F, Nannini S, Fischbach C, Schott R, Bender L. Brain Metastases as Inaugural Sign of Non-Small Cell Lung Carcinoma: Case Series and Review of Literature. Cancers (Basel) 2024; 16:3105. [PMID: 39272963 PMCID: PMC11394598 DOI: 10.3390/cancers16173105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/31/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
In the era of immune checkpoint inhibitors (ICI), managing non-oncogene driven non-small cell lung cancer (NSCLC) with brain metastases (BM) is challenging, especially when brain involvement is the initial sign. Patients with newly diagnosed brain metastatic NSCLC without epidermal growth factor receptor (EFGR) nor anaplastic lymphoma kinase (ALK) alterations were retrospectively included. Twenty-five patients were analyzed; 15 (60%) had symptomatic BM as the first sign (group 1), while 10 (40%) had BM discovered during complementary examinations (group 2). Fourteen patients (56%) had concomitant extracerebral metastases, primarily in group 2. Eight (32%) had oligometastatic disease, with seven in group 1. Over half received chemotherapy and pembrolizumab as first-line treatment. BM surgical resection occurred in twelve (80%) patients in group 1 and one in group 2. Median cerebral progression-free survival was 10 months: 12 in group 1 and 5 in group 2. Median overall survival was 25 months: not reached in group 1 and 6 months in group 2. This case series highlights survival outcomes for patients with inaugural BM, a demographic underrepresented in pivotal trials. Oligometastatic disease and symptomatic BM as initial signs seem associated with better prognosis due to increased use of multimodal local approaches. Combining local approaches with first-line ICI+/- chemotherapy appears to improve survival in brain metastatic NSCLC. A literature review was conducted to explore key questions regarding upfront ICI alone or in combination with systemic drugs or local approaches in brain metastatic NSCLC.
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Affiliation(s)
- Alexandra Pușcașu
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
| | - Fabien Moinard-Butot
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
| | - Simon Nannini
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
| | - Cathie Fischbach
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
| | - Roland Schott
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
| | - Laura Bender
- Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France
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Yang D, Munai E, Zeng S, Tao D, Yuan Z, Du L, Zhou W, Wu Y, Zhu XD. Triple therapy boosts survival in NSCLC patients with brain metastases: a retrospective cohort study of chemotherapy, ICIs, and antiangiogenic agents. Cancer Immunol Immunother 2024; 73:226. [PMID: 39237636 PMCID: PMC11377371 DOI: 10.1007/s00262-024-03797-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/01/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Treatment of brain metastases (BMs) in non-small cell lung cancer (NSCLC) patients, especially those with non-sensitive genetic mutations, is hindered by limited drug delivery through the blood-brain barrier (BBB). This retrospective study explores the efficacy of systemic treatments during brain metastasis to radiotherapy evaluation window in improving patient survival. METHODS In this retrospective cohort study, we evaluated 209 NSCLC patients with non-sensitive mutations and BMs, treated between 2016 and 2023 at two tertiary medical centers (Chongqing University Cancer Hospital and Guangxi Medical University Cancer Hospital). The patients were divided into three groups, namely chemotherapy alone (C; n = 95), chemotherapy plus immune checkpoint inhibitors (ICIs) (C + I; n = 62), and chemotherapy with ICIs and antiangiogenic therapy (A) (C + I + A; n = 52). Statistical analyses were performed using R software, version 4.3.3. Categorical variables were compared using Fisher's exact test, and survival curves were estimated with the Kaplan-Meier method and compared via the log-rank test. Univariate and multivariate Cox regression models were used to assess factors associated with overall survival (OS). Bayesian model averaging (BMA) was employed to address model uncertainty and improve result robustness. Subgroup analyses evaluated treatment-related mortality risk. RESULTS From an initial cohort of 658 NSCLC patients with BMs, 209 were analyzed with a median age of 59; the majority were male (80.9%) and diagnosed with adenocarcinoma (78.9%). Univariate analysis identified significant variables influencing outcomes, including BMs radiotherapy EQD2, BMs count, local thoracic treatment, BMs radiotherapy field, intracranial response, and systemic treatment post-BMs diagnosis. The C + I + A regimen significantly improved median OS to 23.6 months compared to 11.4 months with C and 16.2 months with C + I, with a hazard ratio (HR) of 0.60 (95% CI: 0.43-0.82; P < 0.0001). The two-year OS rate was highest in the C + I + A group at 38.5%, versus 10.5% in C and 20.4% in C + I (P < 0.001). Cox regression and BMA analyses confirmed the stability of BMA in providing HR estimates, yielding area under the curve (AUC) values of 0.785 for BMA and 0.793 for the Cox model, with no significant difference in predictive performance. Subgroup analysis revealed a 71% mortality risk reduction with C + I + A (HR: 0.29; 95% CI: 0.18-0.47; P < 0.0001), showing consistent benefits regardless of patient sex, BMs count, extracranial metastases presence, and local thoracic treatments. Treatment sequence analysis indicated a median OS of 33.4 months for patients starting with A, though not statistically significant (HR: 0.59; P = 0.36). The overall incidence of radiation-induced brain injury was low at 3.3%, with rates in the C, C + I, and C + I + A groups being 3.2%, 4.8%, and 1.9%, respectively (P = 0.683). CONCLUSION Our study demonstrates the significant benefit of the C + I + A combination therapy in improving OS and reducing mortality risk in NSCLC patients with non-sensitive gene-mutated BMs. The sequential administration of A followed by ICIs shows a promising synergistic effect with cranial radiotherapy, highlighting the potential for optimized treatment sequencing. These findings emphasize the efficacy of tailored combination therapies in complex oncological care and suggest that our approach could lead to meaningful improvements in clinical outcomes for this challenging patient population.
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Affiliation(s)
- Dingyi Yang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71, He Di Road, Nanning, 530021, Guangxi, China
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Erha Munai
- School of Medicine, Chongqing University, Chongqing, China
| | - Siwei Zeng
- School of Medicine, Chongqing University, Chongqing, China
| | - Dan Tao
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ze Yuan
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Liang Du
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei Zhou
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China.
| | - Yongzhong Wu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China.
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71, He Di Road, Nanning, 530021, Guangxi, China.
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, China.
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Wu X, Stabile LP, Burns TF. The Emerging Role of Immune Checkpoint Blockade for the Treatment of Lung Cancer Brain Metastases. Clin Lung Cancer 2024; 25:483-501. [PMID: 38991863 DOI: 10.1016/j.cllc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/15/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024]
Abstract
Lung cancer has the highest incidence of brain metastases (BM) among solid organ cancers. Traditionally whole brain radiation therapy has been utilized for non-small-cell lung cancer (NSCLC) BM treatment, although stereotactic radiosurgery has emerged as the superior treatment modality for most patients. Highly penetrant central nervous system (CNS) tyrosine kinase inhibitors have also shown significant CNS activity in patients harboring select oncogenic drivers. There is emerging evidence that patients without oncogene-driven tumors derive benefit from the use of immune checkpoint inhibitors (ICIs). The CNS activity of ICIs have not been well studied given exclusion of patients with active BM from landmark trials, due to concerns of inadequate CNS penetration and activity. However, studies have challenged the idea of an immune-privileged CNS, given the presence of functional lymphatic drainage within the CNS and destruction of the blood brain barrier by BM. An emerging understanding of the interactions between tumor and CNS immune cells in the BM tumor microenvironment also support a role for immunotherapy in BM treatment. In addition, posthoc analyses of major trials have shown improved intracranial response and survival benefit of regimens with ICIs over chemotherapy (CT) alone for patients with BM. Two prospective phase 2 trials evaluating pembrolizumab monotherapy and atezolizumab plus CT in patients with untreated NSCLC BM also demonstrated significant intracranial responses. This review describes the interplay between CNS immune cells and tumor cells, discusses current evidence for ICI CNS activity from retrospective and prospective studies, and speculates on future directions of investigation.
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Affiliation(s)
- Xiancheng Wu
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Laura P Stabile
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Timothy F Burns
- UPMC Hillman Cancer Center, Pittsburgh, PA; Department of Medicine, Division of Hematology-Oncology, University of Pittsburgh, Pittsburgh, PA.
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Xu W, Ye J, Cao Z, Zhao Y, Zhu Y, Li L. Glucocorticoids in lung cancer: Navigating the balance between immunosuppression and therapeutic efficacy. Heliyon 2024; 10:e32357. [PMID: 39022002 PMCID: PMC11252876 DOI: 10.1016/j.heliyon.2024.e32357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 07/20/2024] Open
Abstract
Glucocorticoids (GCs), a class of hormones secreted by the adrenal glands, are released into the bloodstream to maintain homeostasis and modulate responses to various stressors. These hormones function by binding to the widely expressed GC receptor (GR), thereby regulating a wide range of pathophysiological processes, especially in metabolism and immunity. The role of GCs in the tumor immune microenvironment (TIME) of lung cancer (LC) has been a focal point of research. As immunosuppressive agents, GCs exert a crucial impact on the occurrence, progression, and treatment of LC. In the TIME of LC, GCs act as a constantly swinging pendulum, simultaneously offering tumor-suppressive properties while diminishing the efficacy of immune-based therapies. The present study reviews the role and mechanisms of GCs in the TIME of LC.
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Affiliation(s)
| | | | - Zhendong Cao
- Department of Respiration, The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Second Hospital of Traditional Chinese Medicine), Nanjing, Jiangsu, 210017, China
| | - Yupei Zhao
- Department of Respiration, The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Second Hospital of Traditional Chinese Medicine), Nanjing, Jiangsu, 210017, China
| | - Yimin Zhu
- Department of Respiration, The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Second Hospital of Traditional Chinese Medicine), Nanjing, Jiangsu, 210017, China
| | - Lei Li
- Department of Respiration, The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Second Hospital of Traditional Chinese Medicine), Nanjing, Jiangsu, 210017, China
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Brown LJ, Ahn J, Gao B, Gee H, Nagrial A, Hau E, da Silva IP. Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy. Cancers (Basel) 2024; 16:2136. [PMID: 38893255 PMCID: PMC11172392 DOI: 10.3390/cancers16112136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy. In NSCLC, the impact of the distribution of metastatic sites and the response to systemic therapy combinations remain poorly understood. In a retrospective cohort study of patients with unresectable stage III/IV NSCLC who received first-line systemic therapy, we sought to assess the association between the site of metastases with patterns of response and progression. Data regarding demographics, tumour characteristics (including site, size, and volume of metastases), treatment, and outcomes were examined at two cancer care centres. The endpoints included organ site-specific response rate, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Two-hundred and eighty-five patients were included in the analysis. In a multivariate analysis, patients with bone metastases had a reduced ORR, PFS, and OS. Primary resistance was also more likely in patients with bone metastases. Patients with bone or liver metastases had a shorter OS when receiving ICIs with or without chemotherapy, but not with chemotherapy alone, suggesting an immunological basis for therapeutic resistance. A directed assessment of the tumour microenvironment in these locations and a deeper understanding of the drivers of organ-specific resistance to immunotherapy are critical to optimise novel combination therapies and sequencing in these patients.
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Affiliation(s)
- Lauren Julia Brown
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW 2145, Australia (A.N.); (I.P.d.S.)
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Julie Ahn
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Sydney West Radiation Oncology Network (SWRON), Sydney, NSW 2145, Australia
| | - Bo Gao
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW 2145, Australia (A.N.); (I.P.d.S.)
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Harriet Gee
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- Sydney West Radiation Oncology Network (SWRON), Sydney, NSW 2145, Australia
- Children’s Medical Research Institute, Westmead, NSW 2145, Australia
| | - Adnan Nagrial
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW 2145, Australia (A.N.); (I.P.d.S.)
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Eric Hau
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- Sydney West Radiation Oncology Network (SWRON), Sydney, NSW 2145, Australia
| | - Inês Pires da Silva
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW 2145, Australia (A.N.); (I.P.d.S.)
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Sydney, NSW 2148, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Melanoma Institute Australia, Wollstonecraft, NSW 2065, Australia
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Zhang X, Wu M, Chen J, Zheng K, Du H, Li B, Gu Y, Jiang J. Comparative efficacy of immune checkpoint inhibitors combined with chemotherapy in patients with advanced driver-gene negative non-small cell lung cancer: A systematic review and network meta-analysis. Heliyon 2024; 10:e30809. [PMID: 38774326 PMCID: PMC11107224 DOI: 10.1016/j.heliyon.2024.e30809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024] Open
Abstract
Objective To evaluate the efficacy of different combinations of immune checkpoint inhibitors (ICIs) and chemotherapy (CT) in the treatment of advanced non-small cell lung cancer (NSCLC). Methods We obtained relevant randomized controlled trials (RCTs) from databases such as PubMed, Embase, Web of Science, and The Cochrane Library up to May 31, 2023. The analysis of clinical prognostic factors was performed using R 4.2.3 and STATA 15.0. The main outcomes measured were overall survival (OS) and progression-free survival (PFS), while secondary outcomes included the objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events of grade 3-5 severity (Grade ≥3 TRAE). Results A total of 17 randomized controlled trials (RCTs) were conducted between 2012 and 2023, involving 7792 patients. These trials evaluated 11 different treatment methods. The results of these trials showed that in terms of overall survival (OS) and progression-free survival (PFS), the combination of tislelizumab with chemotherapy and the combination of camrelizumab with chemotherapy were particularly effective. Moreover, when compared with other combination therapies, pembrolizumab combined with chemotherapy showed superiority in terms of disease control rate (DCR) and objective response rate (ORR). Subgroup analyses further demonstrated that the addition of immune checkpoint inhibitors (ICIs) to chemotherapy significantly improved PFS and OS in patients without liver metastasis and in those with brain metastasis. Additionally, carboplatin-based combination therapy was found to confer favorable survival benefits in terms of PFS, while cisplatin-based combination therapy showed the most favorable outcomes in terms of OS. The results of subgroup analyses for overall survival (OS) showed that the combination of immunotherapy and chemotherapy yielded positive outcomes in specific subgroups. These subgroups were characterized by PD-L1 Tumor Proportion Score (TPS) of 50 % or higher, usage of anti-PD-1 medications, age below 65, male gender, smoking history, and non-squamous cell carcinoma histology. Superior effectiveness was demonstrated only in extending the progression-free survival (PFS) of female patients and patients with squamous carcinoma. Meanwhile, other patient cohorts did not show the same level of improvement. Conclusions Tislelizumab, camrelizumab or pembrolizumab combined with chemotherapy may be the optimal first-line treatment strategies for NSCLC.
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Affiliation(s)
- Xuewen Zhang
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Min Wu
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Jie Chen
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Kaiman Zheng
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Huchen Du
- Department of Oncology, 903 Hosptial, Sichuan, China
| | - Bo Li
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Yujia Gu
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Jun Jiang
- Division III, Department of Medical Oncology, Affiliated Hospital of Qinghai University, Qinghai, China
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Li X, Wu D, Tang J, Wu Y. The efficiency and safety of temozolomide and PD-1/L1 inhibitors in pretreated NSCLC with brain metastasis: a retrospective cohort. J Cancer Res Clin Oncol 2024; 150:271. [PMID: 38780840 PMCID: PMC11116215 DOI: 10.1007/s00432-024-05808-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Previous research has shown that both temozolomide (TMZ) and PD-1/L1 inhibitors (PD-1/L1) alone exhibit certain potential in the treatment of non-small cell lung cancer (NSCLC) with brain metastases (BM), in this study, we will explore combining the two in order to seek new effective treatment options for NSCLC with BM. MATERIAL AND METHODS During 2021.1 to 2023.12, we collected the date of these pretreated-NSCLC with BM who accept the treatment of TMZ and PD-1/L1, the objective response ratio (ORR), progression-free survival (PFS) and overall survival (OS) were set as the primary endpoint, meanwhile, the toxicity of such regimen was also recorded. RESULTS About 42 patients are enrolled, our primary analysis demonstrated that the ORR of such regimen toward NSCLC with BM was 26.19%, with Approximate intracranial and extracranial lesion ORR was 6% and 20% respectively, the DCR was about 64.29%, the mean PFS and OS was about 4 m and 8.5 m. Further analysis indicated that the efficiency correlated with the diagnosis-Specific Graded Prognostic Assessment (ds-GPA) score. Moreover, the toxicity can also be tolerated, indicating the application potential of such regimen against NSCLC with BM. CONCLUSIONS Our results exhibited that with tolerated toxicity, the combination of TMZ and PD-1/L1 shows promising efficiency against NSCLC with BM, this would be of great significance for the treatment of NSCLC with brain metastasis. However, due to the limitation of sample and retrospective property, the real value of such regimen needed to be further confirmed in the future.
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Affiliation(s)
- Xiaobing Li
- Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - De Wu
- The Centre of Molecular Diagnosis, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Tang
- Department of Lymphoma, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuebing Wu
- Department of Lymphoma, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Chen S, Li T, Yang W, Wang T, Qin Y, Du Z, Li Y, Cui P, Hu Y, Liu Z. Comparative efficacy of six programmed cell death Protein-1 inhibitors as first-line treatment for advanced non-small cell lung cancer: a multicenter retrospective cohort study. Front Pharmacol 2024; 15:1390872. [PMID: 38835662 PMCID: PMC11148465 DOI: 10.3389/fphar.2024.1390872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
The purpose of this study was to assess the comparative efficacy of six programmed cell death-1 inhibitors (nivolumab, pembrolizumab, sintilimab, tislelizumab, toripalimab, and camrelizumab) that have been used as first-line therapy for Chinese patients with advanced non-small cell lung cancer (NSCLC), which remains unclear. We determined the differences in efficacy by observing patient survival data, with the goal of informing future treatment options. Retrospective data analysis from June 2015 to April 2023 included 913 patients across six groups: nivolumab (123%, 13.5%), pembrolizumab (421%, 46.1%), sintilimab (239%, 26.1%), tislelizumab (64%, 7.0%), toripalimab (39%, 4.3%), and camrelizumab (27%, 3.0%). The median progression-free survival (PFS) for each group was 16.0, 16.1, 18.4, 16.9, 23.7, and 12.8 months, and the median overall survival (OS) was 33.7, 36.1, 32.5, not reached, 30.9 and 46.0 months for the nivolumab, sintilimab, pembrolizumab, tislelizumab, toripalimab, and camrelizumab groups, respectively. While differences existed in the objective response rates among groups (p < 0.05), there were no significant differences (all p > 0.05) in PFS or OS. The findings suggest comparable efficacy among these PD-1 inhibitors for NSCLC treatment, underscoring their collective suitability and aiding treatment decisions.
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Affiliation(s)
- Siyuan Chen
- Medical School of Chinese PLA, Beijing, China
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tao Li
- Medical School of Chinese PLA, Beijing, China
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenyu Yang
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Ting Wang
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yuhui Qin
- Medical School of Chinese PLA, Beijing, China
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhijuan Du
- Medical School of Chinese PLA, Beijing, China
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yanan Li
- Department of Medical Oncology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Pengfei Cui
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Zhefeng Liu
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
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Phillips W, Thornton Z, Andrews L, Daly R, Higgins J, Davies P, Kurian K. Efficacy of PD-1/PD-L1 immunotherapy on brain metastatic non-small-cell lung cancer and treatment-related adverse events: A systematic review. Crit Rev Oncol Hematol 2024; 196:104288. [PMID: 38331301 DOI: 10.1016/j.critrevonc.2024.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Recent evidence suggests that PD-1/PD-L1 immunotherapy improves outcomes in patients with brain metastatic non-small cell lung cancer. METHODS Records were searched electronically on MEDLINE, Embase and BIOSIS. Hazard ratios and their 95% confidence intervals for overall survival and progression free survival, and treatment-related adverse events data were extracted. Risk of bias was assessed in included studies using the Cochrane Collaboration's revised tool to assess risk of bias in randomized trials. RESULTS PD-1/PD-L1 immunotherapy increased overall survival by 33% and progression free survival by 47% compared with chemotherapy. Two studies had a high risk of bias. Treatment-related adverse events were reported in 95%, 89% and 65% of patients receiving chemoimmunotherapy,chemotherapy and single agent immunotherapy, respectively. CONCLUSION PD-1/PD-L1 inhibitors alone or in addition to chemotherapy increase overall and progression free survival when compared with chemotherapy alone. Chemoimmunotherapy and chemotherapy patients experienced the most treatment-related adverse events.
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Affiliation(s)
- William Phillips
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Zak Thornton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council (MRC) Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom; Cancer Research Integrative Cancer Epidemiology Programme, University of Bristol, Bristol, United Kingdom
| | - Lily Andrews
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council (MRC) Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom; Cancer Research Integrative Cancer Epidemiology Programme, University of Bristol, Bristol, United Kingdom
| | - Richard Daly
- North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Julian Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council (MRC) Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom; Cancer Research Integrative Cancer Epidemiology Programme, University of Bristol, Bristol, United Kingdom
| | - Kathreena Kurian
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council (MRC) Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom; Cancer Research Integrative Cancer Epidemiology Programme, University of Bristol, Bristol, United Kingdom; Brain Tumour Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Nannini S, Guisier F, Curcio H, Ricordel C, Demontrond P, Abdallahoui S, Baloglu S, Greillier L, Chouaid C, Schott R. Outcomes of Patients with Non-Small Cell Lung Cancer and Brain Metastases Treated with the Upfront Single Agent Pembrolizumab: A Retrospective and Multicentric Study of the ESCKEYP GFPC Cohort. Curr Oncol 2024; 31:1656-1666. [PMID: 38534959 PMCID: PMC10969391 DOI: 10.3390/curroncol31030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 05/26/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of brain metastasis (BM). Little is known about immune checkpoint inhibitor activity in the central nervous system, especially in patients receiving monotherapy for tumors with a tumor proportion score (TPS) ≥ 50%. This noninterventional, retrospective, multicenter study, conducted with the GFPC, included treatment-naïve patients strongly positive for PD-L1 (TPS ≥ 50%) with BM receiving first-line single-agent pembrolizumab treatment between May 2017 and November 2019. The primary endpoints were centrally reviewed intracranial overall response rates (ORRs), centrally reviewed intracranial progression-free survival (cPFS), extracranial PFS, and overall survival were secondary endpoints. Forty-three patients from five centers were included. Surgical or local radiation therapy was administered to 31 (72%) patients, mostly before initiating ICI therapy (25/31). Among 38/43 (88.4%) evaluable patients, the intracranial ORR was 73%. The median PFS was 8.3 months. The cerebral and extracerebral median PFS times were 9.2 and 5.3 months, respectively. The median OS was 25.5 months. According to multivariate analysis, BM surgery before ICI therapy was the only factor significantly associated with both improved PFS (HR = 0.44) and OS (HR = 0.45). This study revealed the feasibility and outcome of front-line pembrolizumab treatment in this population with BM.
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Affiliation(s)
- Simon Nannini
- Department of Oncology, Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France; (S.N.); (S.A.)
| | - Florian Guisier
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF Team EA4108, CHU Rouen, Normandie University, Rouen and Inserm CIC-CRB 1404, 76000 Rouen, France
| | - Hubert Curcio
- Department of Pneumology, Centre Régionale de Lutte Contre le Cancer François Baclesse, 14000 Caen, France
| | - Charles Ricordel
- Department of Pneumology, Centre Hospitalier Universitaire, 35000 Rennes, France
| | - Pierre Demontrond
- Department of Pneumology, Centre Régionale de Lutte Contre le Cancer François Baclesse, 14000 Caen, France
| | - Safa Abdallahoui
- Department of Oncology, Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France; (S.N.); (S.A.)
| | - Seyyid Baloglu
- Department of Radiological, Centre Hospitalier Universitaire de Strasbourg, 67200 Strasbourg, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, 13015 Marseille, France
| | - Christos Chouaid
- Department of Pneumology, Centre Hospitalier, 94000 Créteil, France
| | - Roland Schott
- Department of Oncology, Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France; (S.N.); (S.A.)
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Lofiego MF, Piazzini F, Caruso FP, Marzani F, Solmonese L, Bello E, Celesti F, Costa MC, Noviello T, Mortarini R, Anichini A, Ceccarelli M, Coral S, Di Giacomo AM, Maio M, Covre A. Epigenetic remodeling to improve the efficacy of immunotherapy in human glioblastoma: pre-clinical evidence for development of new immunotherapy approaches. J Transl Med 2024; 22:223. [PMID: 38429759 PMCID: PMC10908027 DOI: 10.1186/s12967-024-05040-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is a highly aggressive primary brain tumor, that is refractory to standard treatment and to immunotherapy with immune-checkpoint inhibitors (ICI). Noteworthy, melanoma brain metastases (MM-BM), that share the same niche as GBM, frequently respond to current ICI therapies. Epigenetic modifications regulate GBM cellular proliferation, invasion, and prognosis and may negatively regulate the cross-talk between malignant cells and immune cells in the tumor milieu, likely contributing to limit the efficacy of ICI therapy of GBM. Thus, manipulating the tumor epigenome can be considered a therapeutic opportunity in GBM. METHODS Microarray transcriptional and methylation profiles, followed by gene set enrichment and IPA analyses, were performed to study the differences in the constitutive expression profiles of GBM vs MM-BM cells, compared to the extracranial MM cells and to investigate the modulatory effects of the DNA hypomethylating agent (DHA) guadecitabine among the different tumor cells. The prognostic relevance of DHA-modulated genes was tested by Cox analysis in a TCGA GBM patients' cohort. RESULTS The most striking differences between GBM and MM-BM cells were found to be the enrichment of biological processes associated with tumor growth, invasion, and extravasation with the inhibition of MHC class II antigen processing/presentation in GBM cells. Treatment with guadecitabine reduced these biological differences, shaping GBM cells towards a more immunogenic phenotype. Indeed, in GBM cells, promoter hypomethylation by guadecitabine led to the up-regulation of genes mainly associated with activation, proliferation, and migration of T and B cells and with MHC class II antigen processing/presentation. Among DHA-modulated genes in GBM, 7.6% showed a significant prognostic relevance. Moreover, a large set of immune-related upstream-regulators (URs) were commonly modulated by DHA in GBM, MM-BM, and MM cells: DHA-activated URs enriched for biological processes mainly involved in the regulation of cytokines and chemokines production, inflammatory response, and in Type I/II/III IFN-mediated signaling; conversely, DHA-inhibited URs were involved in metabolic and proliferative pathways. CONCLUSIONS Epigenetic remodeling by guadecitabine represents a promising strategy to increase the efficacy of cancer immunotherapy of GBM, supporting the rationale to develop new epigenetic-based immunotherapeutic approaches for the treatment of this still highly deadly disease.
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Affiliation(s)
| | | | - Francesca Pia Caruso
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples "Federico II", Naples, Italy
| | | | - Laura Solmonese
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | | | | - Maria Claudia Costa
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples "Federico II", Naples, Italy
| | - Teresa Noviello
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Roberta Mortarini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Anichini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Ceccarelli
- BIOGEM Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Anna Maria Di Giacomo
- University of Siena, Siena, Italy
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Michele Maio
- University of Siena, Siena, Italy
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
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Brown LJ, Khou V, Brown C, Alexander M, Jayamanne D, Wei J, Gray L, Chan WY, Smith S, Harden S, Mersiades A, Warburton L, Itchins M, Lee JH, Pavlakis N, Clarke SJ, Boyer M, Nagrial A, Hau E, Pires da Silva I, Kao S, Kong BY. First-line chemoimmunotherapy and immunotherapy in patients with non-small cell lung cancer and brain metastases: a registry study. Front Oncol 2024; 14:1305720. [PMID: 38406805 PMCID: PMC10885799 DOI: 10.3389/fonc.2024.1305720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/08/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Brain metastases commonly occur in patients with non-small cell lung cancer (NSCLC). Standard first-line treatment for NSCLC, without an EGFR, ALK or ROS1 mutation, is either chemoimmunotherapy or anti-PD-1 monotherapy. Traditionally, patients with symptomatic or untreated brain metastases were excluded from the pivotal clinical trials that established first-line treatment recommendations. The intracranial effectiveness of these treatment protocols has only recently been elucidated in small-scale prospective trials. Methods Patients with NSCLC and brain metastases, treated with first-line chemoimmunotherapy or anti-PD-1 monotherapy were selected from the Australian Registry and biObank of thoracic cancers (AURORA) clinical database covering seven institutions. The primary outcome was a composite time-to-event (TTE) outcome, including extracranial and intracranial progression, death, or need for local intracranial therapy, which served as a surrogate for disease progression. The secondary outcome included overall survival (OS), intracranial objective response rate (iORR) and objective response rate (ORR). Results 116 patients were included. 63% received combination chemoimmunotherapy and 37% received anti-PD-1 monotherapy. 69% of patients received upfront local therapy either with surgery, radiotherapy or both. The median TTE was 7.1 months (95% CI 5 - 9) with extracranial progression being the most common progression event. Neither type of systemic therapy or upfront local therapy were predictive of TTE in a multivariate analysis. The median OS was 17 months (95% CI 13-27). Treatment with chemoimmunotherapy was predictive of longer OS in multivariate analysis (HR 0.35; 95% CI 0.14 - 0.86; p=0.01). The iORR was 46.6%. The iORR was higher in patients treated with chemoimmunotherapy compared to immunotherapy (58% versus 31%, p=0.01). The use of chemoimmunotherapy being predictive of iORR in a multivariate analysis (OR 2.88; 95% CI 1.68 - 9.98; p=0.04). Conclusion The results of this study of real-world data demonstrate the promising intracranial efficacy of chemoimmunotherapy in the first-line setting, potentially surpassing that of immunotherapy alone. No demonstrable difference in survival or TTE was seen between receipt of upfront local therapy. Prospective studies are required to assist clinical decision making regarding optimal sequencing of local and systemic therapies.
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Affiliation(s)
- Lauren Julia Brown
- Translational Radiation Biology and Oncology Group, Westmead Institute for Medical Research, Westmead, NSW, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Victor Khou
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour, NSW, Australia
| | - Chris Brown
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Dasantha Jayamanne
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Genesis Care, St Leonards, NSW, Australia
| | - Joe Wei
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lauren Gray
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Wei Yen Chan
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Samuel Smith
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
| | - Susan Harden
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Department of Radiation Oncology, Sir Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Antony Mersiades
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Northern Beaches Hospital, Frenches Forest, NSW, Australia
| | - Lydia Warburton
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Malinda Itchins
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Genesis Care, St Leonards, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jenny H. Lee
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Nick Pavlakis
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Genesis Care, St Leonards, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Stephen J. Clarke
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Genesis Care, St Leonards, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Boyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric Hau
- Translational Radiation Biology and Oncology Group, Westmead Institute for Medical Research, Westmead, NSW, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ines Pires da Silva
- Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, Wollstonecraft, NSW, Australia
| | - Steven Kao
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
| | - Benjamin Y. Kong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Cancer Clinical Academic Group, Faculty of Medicine, University of New South Wales (NSW), Sydney, NSW, Australia
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Dipasquale A, Barigazzi C, Losurdo A, Persico P, Di Muzio A, Navarria P, Pessina F, van den Bent M, Santoro A, Simonelli M. Brain metastases and next-generation anticancer therapies: a survival guide for clinicians. Crit Rev Oncol Hematol 2024; 194:104239. [PMID: 38128629 DOI: 10.1016/j.critrevonc.2023.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Historically, patients with brain metastases (BMs) have been characterized by few systemic treatment options and poor prognosis. The recent introduction of next-generation anticancer therapies such as molecular targeted agents and immunotherapy have revolutionized the clinical decision-making process of this sub-population, posing new challenges to physicians. In this review, current evidence for the use of checkpoint inhibitors and targeted therapies in patients with BMs are discussed, with a focus on lung cancer, breast cancer, melanoma and renal cell carcinoma, providing suggestions and potential workflows for daily clinical practice. Several other on-going and future challenges, such as clinical trials design, ways to improve CNS penetration of novel drugs and unique molecular characteristics of BMs, are also discussed. The aim is producing an updated and easy-to-read guide for physicians, to improve decision-making in clinical practice.
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Affiliation(s)
- Angelo Dipasquale
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara Barigazzi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Agnese Losurdo
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pasquale Persico
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Di Muzio
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Piera Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Simonelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Uprety D, Remon J, Peters S. First-Line Dual Immunotherapy, a Treatment Option in First-Line Metastatic Non-Small-Cell Lung Cancer: Are We Ready to Use It? J Clin Oncol 2024; 42:378-382. [PMID: 38033277 DOI: 10.1200/jco.23.01524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/20/2023] [Accepted: 10/06/2023] [Indexed: 12/02/2023] Open
Abstract
This article provides valuable insights into the use of dual immunotherapy for patients with metastatic NSCLC.
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Affiliation(s)
- Dipesh Uprety
- Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
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45
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Guo H, Zhang J, Qin C, Yan H, Luo X, Zhou H. Advances and challenges of first-line immunotherapy for non-small cell lung cancer: A review. Medicine (Baltimore) 2024; 103:e36861. [PMID: 38241591 PMCID: PMC10798763 DOI: 10.1097/md.0000000000036861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024] Open
Abstract
The current use of immune checkpoint inhibitors (ICIs) for the treatment of lung cancer has dramatically changed the clinical strategy for metastatic non-small cell lung cancer (mNSCLC). As a result of great achievements in clinical trials, 6 programmed death-1 inhibitors (sintilimab, camrelizumab, tislelizumab, pembrolizumab, cemiplimab, and nivolumab), 2 programmed death-ligand 1 inhibitors (sugemalimab and atezolizumab), and 1 cytotoxic T lymphocyte-associated antigen-4 inhibitor (ipilimumab) have been approved as first-line treatment for mNSCLC by the US Food and Drug Administration. Recently, research on ICIs has shifted from a large number of second-line to first-line settings in clinical trials. Results from first-line trials have shown that almost all driver-negative mNSCLC are treated with ICIs and significantly prolong patient survival; however, the low response rate and adverse reactions to immunotherapy remain to be addressed. Here, we summarize the use of ICIs, including monotherapy and combination therapy, in the first-line treatment of mNSCLC in recent years and discuss the low response rate and adverse reactions of ICIs as well as the challenges and expectations for the first-line treatment of mNSCLC in the future.
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Affiliation(s)
- Haiyang Guo
- Institute of Surgery, School of Medicine and Life Sciences, Chengdu University of TCM, Chengdu, China
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Jun Zhang
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
- Institute of Surgery, Graduate School, Zunyi Medical University, Zunyi, China
| | - Chao Qin
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
- Institute of Surgery, Graduate School, Zunyi Medical University, Zunyi, China
| | - Hang Yan
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
- Institute of Surgery, Graduate School, Zunyi Medical University, Zunyi, China
| | - Xinyue Luo
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Haining Zhou
- Institute of Surgery, School of Medicine and Life Sciences, Chengdu University of TCM, Chengdu, China
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
- Institute of Surgery, Graduate School, Zunyi Medical University, Zunyi, China
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Sereno M, Hernandez de Córdoba I, Gutiérrez-Gutiérrez G, Casado E. Brain metastases and lung cancer: molecular biology, natural history, prediction of response and efficacy of immunotherapy. Front Immunol 2024; 14:1297988. [PMID: 38283359 PMCID: PMC10811213 DOI: 10.3389/fimmu.2023.1297988] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Brain metastases stemming from lung cancer represent a common and challenging complication that significantly impacts patients' overall health. The migration of these cancerous cells from lung lesions to the central nervous system is facilitated by diverse molecular changes and a specific environment that supports their affinity for neural tissues. The advent of immunotherapy and its varied combinations in non-small cell lung cancer has notably improved patient survival rates, even in cases involving brain metastases. These therapies exhibit enhanced penetration into the central nervous system compared to traditional chemotherapy. This review outlines the molecular mechanisms underlying the development of brain metastases in lung cancer and explores the efficacy of novel immunotherapy approaches and their combinations.
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Affiliation(s)
- Maria Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Instituto Madrileño Investigación Estudios Avanzados (IMDEA), Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI Universidad Autónoma de Madrid (UAM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | | | - Gerardo Gutiérrez-Gutiérrez
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Neurology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Instituto Madrileño Investigación Estudios Avanzados (IMDEA), Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI Universidad Autónoma de Madrid (UAM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
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Gridelli C, Peters S, Mok T, Garassino M, Paz-Ares L, Attili I, de Marinis F. Face to face among different chemo-immunotherapy combinations in the first line treatment of patients with advanced non-small cell lung cancer: Results of an international expert panel meeting by the italian association of thoracic oncology (AIOT). Lung Cancer 2024; 187:107441. [PMID: 38141488 DOI: 10.1016/j.lungcan.2023.107441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND The combination of platinum-based chemotherapy with immune-checkpoint inhibitors (ICIs) is a standard of care option in the front-line treatment of advanced non-small cell lung cancer (NSCLC). Positive efficacy and safety results have been demonstrated with different chemo-ICI combinations in the corresponding clinical trials, however no randomized prospective comparison is available and there is no evidence on how to choose among the available regimens. METHODS A virtual International Expert Panel took place in July 2023 to review data on chemo-ICI regimens available in the first-line setting in patients with NSCLC, and reach common considerations both in clinical practice and in research setting. RESULTS Overall, all panelists agreed that safety of the chemo-immunotherapy combination regimens is supported by reviewed data, showing no additional toxicity concerns over those of the individual components of each regimen and highlighting differences in toxicity profile based on ICI component (single anti-PD-1 versus double anti-PD-1 and anti-CTLA-4). Among disease characteristics, PD-L1 value (<1%) but not histology was considered a potential selection factor in favor of the combination with dual ICI. With regards to clinical features, the panelists agreed that chemotherapy, whichever the ICI combination regimen, remains the backbone to counteract disease-related symptoms included those conditioning worse performance status. The panelists defined high, medium, and low priorities in clinical research. High priority was attributed to prospectively evaluating the impact of the addition of anti-CTLA-4 on brain metastasis, biomarker subgroups, and the optimal duration and schedule of combination regimens. CONCLUSIONS Based on the available evidence, the panelists reached common considerations on strengths and differences between chemotherapy plus single agent ICI and chemotherapy plus double agent ICIs in patients with advanced NSCLC. In the absence of direct comparison, different toxicity profile and subgroup analysis by PD-L1 are considered as the main potential features to select among the two regimens, however to be confirmed by recommended prospective randomized clinical research.
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Affiliation(s)
- Cesare Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy.
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Tony Mok
- Department of Clinical Oncology, Faculty of Medicine, State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Marina Garassino
- Knapp Center for Biomedical Discovery, University of Chicago Medicine & Biological Sciences, Chicago, IL, USA
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, H12O-CNIO Lung Cancer Clinical Research Unit, Universidad Complutense & CiberOnc, Madrid, Spain
| | - Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
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Zhou D, Gong Z, Wu D, Ma C, Hou L, Niu X, Xu T. Harnessing immunotherapy for brain metastases: insights into tumor-brain microenvironment interactions and emerging treatment modalities. J Hematol Oncol 2023; 16:121. [PMID: 38104104 PMCID: PMC10725587 DOI: 10.1186/s13045-023-01518-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Brain metastases signify a deleterious milestone in the progression of several advanced cancers, predominantly originating from lung, breast and melanoma malignancies, with a median survival timeframe nearing six months. Existing therapeutic regimens yield suboptimal outcomes; however, burgeoning insights into the tumor microenvironment, particularly the immunosuppressive milieu engendered by tumor-brain interplay, posit immunotherapy as a promising avenue for ameliorating brain metastases. In this review, we meticulously delineate the research advancements concerning the microenvironment of brain metastases, striving to elucidate the panorama of their onset and evolution. We encapsulate three emergent immunotherapeutic strategies, namely immune checkpoint inhibition, chimeric antigen receptor (CAR) T cell transplantation and glial cell-targeted immunoenhancement. We underscore the imperative of aligning immunotherapy development with in-depth understanding of the tumor microenvironment and engendering innovative delivery platforms. Moreover, the integration with established or avant-garde physical methodologies and localized applications warrants consideration in the prevailing therapeutic schema.
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Affiliation(s)
- Dairan Zhou
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Zhenyu Gong
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Dejun Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Chao Ma
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, People's Republic of China
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, People's Republic of China.
| | - Tao Xu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
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Li M, Chen J, Yu H, Zhang B, Hou X, Jiang H, Xie D, Chen L. Cerebrospinal fluid immunological cytokines predict intracranial tumor response to immunotherapy in non-small cell lung cancer patients with brain metastases. Oncoimmunology 2023; 13:2290790. [PMID: 38169917 PMCID: PMC10761018 DOI: 10.1080/2162402x.2023.2290790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Background Immunotherapy has shown intracranial efficacy in non-small cell lung cancer (NSCLC) patients with brain metastases. However, predictive biomarkers for intracranial response to immunotherapy are lacking. This post-hoc analysis aimed to explore the potential of immunological cytokines in cerebrospinal fluid (CSF) to predict intracranial tumor response to immunotherapy in patients with brain metastases. Methods Treatment-naive NSCLC patients with brain metastases who received camrelizumab plus chemotherapy were enrolled. Paired plasma and CSF samples were prospectively collected at baseline and the first treatment assessment. All samples were analyzed for 92 immuno-oncology cytokines using Olink's panels. Results A total of 28 patients were included in this analysis. At baseline, most immunological cytokines were significantly lower in CSF than in plasma, whereas a subset comprising CD83, PTN, TNFRSF21, TWEAK, ICOSLG, DCN, IL-8, and MCP-1, was increased in CSF. Baseline CSF levels of LAMP3 were significantly higher in patients with intracranial tumor response, while the levels of CXCL10, IL-12, CXCL11, IL-18, TIE2, HGF, and PDCD1 were significantly lower. Furthermore, the CXCL10, CXCL11, TIE2, PDCD1, IL-18, HGF, and LAMP3 in CSF were also significantly associated with intracranial progression-free survival for immunotherapy. The identified cytokines in CSF were decreased at the first treatment evaluation in patients with intracranial tumor response. The logistic CSF immuno-cytokine model yielded an AUC of 0.91, as compared to PD-L1 expression (AUC of 0.72). Conclusions Immunological cytokines in CSF could predict intracranial tumor response to immunotherapy in NSCLC patients with brain metastases, and the findings warrant validation in a larger prospective cohort study. Trial registration ClinicalTrials.gov identifier: NCT04211090.
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Affiliation(s)
- Meichen Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Hui Yu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Baishen Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Honghua Jiang
- Department of Oncology, Southern Theater Air Force Hospital, Guangzhou, China
| | - Dan Xie
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Likun Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
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Zhao WH, Wang SF, Su CY, Pan XB. Efficacy of First-Line Immunotherapy Combined With Chemotherapy in Extensive-Stage Small Cell Lung Cancer Patients With Different Brain Metastases Status: A Systematic Review and Meta-Analysis. World J Oncol 2023; 14:529-539. [PMID: 38022408 PMCID: PMC10681790 DOI: 10.14740/wjon1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to evaluate the efficacy of first-line immunotherapy combined with chemotherapy in extensive-stage small cell lung cancer (ES-SCLC) patients with differing brain metastasis statuses. Methods We conducted a comprehensive search in public databases, such as PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials involving ES-SCLC patients, with or without brain metastases, who underwent first-line immunotherapy combined with chemotherapy. The primary outcome measure was progression-free survival (PFS), and the secondary outcome measure was overall survival (OS). Results Our analysis incorporated seven high-quality randomized controlled trials, encompassing 398 patients with brain metastases and 3,533 without. Among patients without brain metastases, the combination of immunotherapy and chemotherapy led to significantly improved PFS (hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.62 - 0.84, P < 0.001) and OS (HR = 0.77, 95% CI: 0.67 - 0.88, P < 0.001) in comparison to chemotherapy alone. Conversely, for patients with brain metastases, the addition of immunotherapy to chemotherapy did not result in a significant improvement in PFS (HR = 1.03, 95% CI: 0.66 - 1.61, P = 0.887) or OS (HR = 1.03, 95% CI: 0.82 - 1.31, P = 0.776) when compared to chemotherapy alone. Conclusions In ES-SCLC patients without brain metastases, first-line immunotherapy combined with chemotherapy demonstrated improved PFS and OS in contrast to chemotherapy alone. However, patients with brain metastases did not experience similar benefits.
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Affiliation(s)
- Wen Hua Zhao
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China
- These authors contributed equally to this work
| | - Shou Feng Wang
- Department of Thoracic Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China
- These authors contributed equally to this work
| | - Cui Yun Su
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China
| | - Xin Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China
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