O'Kane Grainne M, Leighl Natasha B
Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Transl Lung Cancer Res. 2016 Dec;5(6):628-636. doi: 10.21037/tlcr.2016.09.05.
Brain metastases occur in approximately half of patients with non-small cell lung cancer (NSCLC) and are associated with a poor prognosis and an inferior quality of life. Historically systemic therapy has had a limited role in CNS disease with a reliance placed on local treatments. The emergence of targeted therapies and immune checkpoint inhibitors (ICIs) in recent years has dramatically changed the treatment landscape of NSCLC. Programmed cell death-1 (PD-1) inhibitors have demonstrated efficacy in three randomized trials and now represent standard second line therapy after platinum failure. Trials have largely excluded patients with symptomatic or untreated CNS disease as the brain has been considered an 'immune-privileged' organ. We review the evidence and future prospects of ICIs in treating brain metastases in NSCLC.
脑转移瘤发生于约半数非小细胞肺癌（NSCLC）患者中，与预后不良及生活质量较差相关。从历史上看，全身治疗在中枢神经系统疾病中的作用有限，主要依赖局部治疗。近年来，靶向治疗和免疫检查点抑制剂（ICI）的出现极大地改变了NSCLC的治疗格局。程序性细胞死亡蛋白1（PD-1）抑制剂在三项随机试验中已证明有效，目前已成为铂类治疗失败后的标准二线治疗方案。由于大脑被认为是一个“免疫豁免”器官，试验在很大程度上排除了有症状或未经治疗的中枢神经系统疾病患者。我们综述了ICI治疗NSCLC脑转移瘤的证据及未来前景。
