Evaluating the Therapeutic Impact of Immune Checkpoint Inhibitors in the Management of Brain Metastases from Non-Small Cell Lung Cancer
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Published on: August 2, 2022
Keren Rouvinov1,2, Rashad Naamneh2,3, Alexander Yakobson1,2
1The Legacy Heritage Cancer Center, Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva 84105, Israel.
Background:
Non-small cell lung cancer (NSCLC) patients often develop brain metastases (BMs), with an incidence rate of 25-40%. These metastases are associated with a poor prognosis. Although immune checkpoint inhibitors (ICIs) have revolutionized NSCLC treatment, their effectiveness against BMs remains not well-established. This is primarily because patients with active or symptomatic BMs have frequently been excluded from clinical trials.
Methods:
To address the lack of data, in this narrative review, we searched the available clinical guidelines and relevant studies. Databases, including PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, were searched for clinical studies published up to June 2025. The article included studies of NSCLC patients with BMs who were treated with ICIs and had reported central nervous system (CNS)-specific outcomes.
Results:
This article found that ICIs show significant intracranial activity. This activity is particularly notable in select NSCLC patients with asymptomatic BMs and high Programmed Death-Ligand 1 (PD-L1) expression.
Conclusions:
More research is needed to fully understand the efficacy of ICIs in treating BMs. Future prospective studies must include patients with active and symptomatic BMs to validate these findings and provide a clearer picture of ICI efficacy in this patient population.
Insights
Immune checkpoint inhibitors (ICIs) show promise for non-small cell lung cancer (NSCLC) brain metastases (BMs), especially in asymptomatic patients with high PD-L1 expression. Further research including symptomatic patients is needed to confirm ICI efficacy.
Area of Science:
- Oncology
- Immunotherapy
- Neurology
Background:
- Brain metastases (BMs) affect 25-40% of non-small cell lung cancer (NSCLC) patients, leading to poor prognosis.
- Immune checkpoint inhibitors (ICIs) have transformed NSCLC treatment but their efficacy in BMs is unclear.
- Patients with active or symptomatic BMs are often excluded from clinical trials, limiting data.
Purpose of the Study:
- To review the current evidence on the efficacy of ICIs in NSCLC patients with BMs.
- To assess the intracranial activity of ICIs in this specific patient population.
Main Methods:
- A narrative review of clinical guidelines and studies.
- Searched PubMed, MEDLINE, Embase, CENTRAL, and Web of Science up to June 2025.
- Included studies of NSCLC patients with BMs treated with ICIs, reporting CNS outcomes.
Main Results:
- ICIs demonstrate significant intracranial activity in NSCLC patients with BMs.
- Efficacy is particularly noted in patients with asymptomatic BMs and high Programmed Death-Ligand 1 (PD-L1) expression.
Conclusions:
- Further research is essential to fully elucidate ICI efficacy for BMs.
- Prospective studies incorporating patients with active/symptomatic BMs are required to validate findings and clarify treatment effectiveness.
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