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Complications associated with immunotherapy for brain metastases
Thuy T Tran1,2, Lucia B Jilaveanu1,2, Antonio Omuro1,2,3
1Yale Cancer Center.
Purpose Of Review:
Median survival after the diagnosis of brain metastases has historically been on the order of months. With the recent development of immune checkpoint inhibitors, intracranial activity and durable responses have been observed in brain metastases on multiple phase 2 clinical trials, which have primarily been conducted in patients with melanoma. Immune-related adverse events related to checkpoint inhibitor therapy of brain metastasis can present unique challenges for the clinician and underscore the need for a multidisciplinary team in the care of these patients. The goal of this review is to address the current knowledge, limitations of understanding, and future directions in research regarding immune therapy trials and neurologic toxicities based on retrospective, prospective, and case studies.
Recent Findings:
Immune therapy has the potential to exacerbate symptomatic edema and increase the risk of radiation necrosis in previously irradiated lesions. Neurologic toxicities will likely increase in prevalence as more patients with brain metastatic disease are eligible for immune therapy.
Summary:
An improved understanding and heightened awareness of the unique neurologic toxicities that impact this patient group is vital for mitigating treatment-related morbidity and mortality.
Insights
Immune checkpoint inhibitors show promise for brain metastases, but can cause unique neurologic toxicities. Awareness and multidisciplinary care are crucial for managing these side effects in patients with brain metastatic disease.
Area of Science:
- Neuro-oncology
- Immunotherapy
- Clinical Trials
Background:
- Brain metastases historically have limited survival.
- Immune checkpoint inhibitors are emerging as a treatment for brain metastases, particularly in melanoma.
- Immune-related adverse events present unique challenges in managing brain metastases.
Purpose of the Study:
- To review current knowledge on immunotherapy for brain metastases.
- To identify limitations in understanding treatment-related neurologic toxicities.
- To outline future research directions for immunotherapy in brain metastases.
Main Methods:
- Review of retrospective studies.
- Analysis of prospective clinical trials.
- Examination of case studies.
Main Results:
- Immune checkpoint inhibitors demonstrate intracranial activity and durable responses in brain metastases.
- Immune therapy can worsen edema and increase radiation necrosis risk.
- Neurologic toxicities are expected to increase with broader eligibility for immunotherapy.
Conclusions:
- Enhanced understanding of neurologic toxicities is vital.
- Heightened awareness is necessary for mitigating treatment-related morbidity and mortality.
- Multidisciplinary care is essential for patients receiving immunotherapy for brain metastases.
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