Pușcașu Alexandra, Moinard-Butot Fabien, Nannini Simon, Fischbach Cathie, Schott Roland, Bender Laura
Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200 Strasbourg, France.
Cancers (Basel). 2024 Sep 8;16(17):3105. doi: 10.3390/cancers16173105.
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.
在免疫检查点抑制剂（ICI）时代，管理伴有脑转移（BM）的非癌基因驱动的非小细胞肺癌（NSCLC）具有挑战性，尤其是当脑部受累为首发症状时。回顾性纳入了新诊断的无脑表皮生长因子受体（EFGR）和间变性淋巴瘤激酶（ALK）改变的脑转移NSCLC患者。分析了25例患者；15例（60%）以有症状的BM为首发症状（第1组），而10例（40%）在辅助检查期间发现BM（第2组）。14例患者（56%）伴有脑外转移，主要在第2组。8例（32%）为寡转移疾病，第1组有7例。超过一半的患者接受化疗和帕博利珠单抗作为一线治疗。第1组12例（80%）患者和第2组1例患者进行了BM手术切除。脑无进展生存期的中位数为10个月：第1组为12个月，第2组为5个月。总生存期的中位数为25个月：第1组未达到，第2组为6个月。该病例系列突出了首发BM患者的生存结果，这一人群在关键试验中的代表性不足。寡转移疾病和有症状的BM作为初始症状似乎因多模式局部治疗方法的使用增加而与更好的预后相关。将局部治疗方法与一线ICI±化疗相结合似乎可改善脑转移NSCLC患者的生存。进行了一项文献综述，以探讨关于在脑转移NSCLC中单独使用 upfront ICI或与全身药物或局部治疗方法联合使用的关键问题。
