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Management of Brain Metastases in the New Era of Checkpoint Inhibition

  • Neuro-Oncology (LE Abrey, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Brain metastasis is a common complication of advanced malignancies, especially, lung cancer, breast cancer, renal cell carcinoma, and melanoma. Traditionally surgery, when indicated, and radiation therapy, either as whole-brain radiation therapy or stereotactic radiosurgery, constituted the major treatment options for brain metastases. Until recently, most of the systemic chemotherapy agents had limited activity for brain metastases. However, with the advent of small molecule tyrosine kinase inhibitors and immunotherapy agents, there has been renewed interest in using these agents in the management of brain metastases.

Recent Findings

Immune checkpoint inhibitors have revolutionized the treatment of metastatic melanoma, lung cancer, kidney cancer, and bladder cancer among others. They modulate the immune system to recognize tumor antigens as “non-self” antigens and mount an immune response against them.

Summary

Initial studies of using immune checkpoint inhibitors in brain metastases have shown promising activity, and several clinical trials are currently underway. Studies are also assessing the combination of radiation therapy and immunotherapy in brain metastases. The results of these ongoing clinical trials have the potential to change the therapeutic paradigm in patients with brain metastases.

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Authors and Affiliations

  1. Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA

    Adam Lauko & Manmeet S. Ahluwalia

  2. Fairview Hospital-Cleveland Clinic, Cleveland, OH, USA

    Bicky Thapa

  3. University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Vyshak Alva Venur

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  1. Adam Lauko
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  2. Bicky Thapa
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  3. Vyshak Alva Venur
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  4. Manmeet S. Ahluwalia
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Correspondence to Manmeet S. Ahluwalia.

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Conflict of Interest

Adam Lauko, Bicky Thapa, and Vyshak Alva Venur declare no conflict of interest.

Manmeet S. Ahluwalia has received grants from Tracon and Novartis, personal fees from Monteris Medical, Caris Life Sciences, MRI Solutions, CBT Pharmaceuticals, Flatiron, Varian, and VBI vaccines, personal fees and grants from Elekta, Incyte, BMS, AstraZeneca, Novocur, and Abbvie, and has received personal fees and has stock options in Mimivax.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Neuro-oncology

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Lauko, A., Thapa, B., Venur, V.A. et al. Management of Brain Metastases in the New Era of Checkpoint Inhibition. Curr Neurol Neurosci Rep 18, 70 (2018). https://doi.org/10.1007/s11910-018-0877-8

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