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A brief report on incidence, radiographic feature and prognostic significance of brain MRI changes after anti-PD-1/PD-L1 therapy in advanced non-small cell lung cancer

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Abstract

Introduction

Neurologic immune-related adverse events (nirAEs) are uncommon but potentially lethal complications of immune checkpoint inhibitor (ICI) treatment. However, the incidence, radiographic features and prognostic significance of brain magnetic resonance imaging (MRI) changes after ICI treatment remain largely unknown.

Methods

Consecutive patients with advanced non-small cell lung cancer (NSCLC) at three participating institutions receiving anti-PD-1/PD-L1 therapy from June 2017 to September 2020 were screened, and those who received brain MRI within 6 weeks before ICI initiation and at least one follow-up brain MRI after ICI treatment were included. Serial brain MRI images were independently reviewed by two experienced radiologists.

Results

With a median follow-up of 13.2 months, 27 (20.0%) of the 135 enrolled patients developed certain kind of brain MRI aberration. The 1-, 2- and 3-year cumulative incidence of brain MRI aberration was 17.1%, 36.3% and 52.2%, respectively. Brain MRI aberration indicative of stroke, mimicking typical white matter lesions and presenting as T2-hyperintensity suggestive of CNS vasculitis or encephalitis, was documented in 11, 9 and 4 patients, respectively. Patients with brain MRI aberration had higher clinical benefit rate (p = 0.030), longer progression-free survival (p = 0.015) and a tendency of improved overall survival (p = 0.054).

Conclusions

Brain MRI aberrations developed after ICI treatment are not uncommon, and their manifestations vary a lot. Patients developing brain MRI aberrations tended to have better prognosis, which needed to be further investigated.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the Chinese Society of Clinical Oncology (CSCO) foundation [grant numbers Y-BMS2019082].

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Author notes

  1. Jianjiao Ni, Yue Zhou and Shengping Wang have contributed equally.

Authors and Affiliations

  1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Jianjiao Ni, Yue Zhou, Tiantian Guo, Xi Yang, Li Chu, Xiao Chu, Yida Li & Zhengfei Zhu

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Jianjiao Ni, Yue Zhou, Shengping Wang, Tiantian Guo, Xi Yang, Li Chu, Xiao Chu, Yida Li & Zhengfei Zhu

  3. Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China

    Shengping Wang

  4. Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China

    Jie Hu

  5. Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Qian Chu

  6. Institute of Thoracic Oncology, Fudan University, 270 Dong An Road, Shanghai, 200032, China

    Zhengfei Zhu

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  1. Jianjiao Ni
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Contributions

Jianjiao Ni was involved in conceptualization, formal analysis, methodology and writing—original draft. Yue Zhou was involved in conceptualization, formal analysis and writing—original draft. Shengping Wang was involved in conceptualization, formal analysis, methodology and writing—review & editing. Tiantian Guo was involved in data curation and formal analysis. Jie Hu was involved in data curation and writing—review & editing. Qian Chu was involved in data curation and writing—review & editing. Xi Yang was involved in data curation. Li Chu was involved in data curation. Xiao Chu was involved in data curation. Yida Li was involved in data curation. Zhengfei Zhu was involved in funding acquisition, supervision and writing—review & editing.

Corresponding author

Correspondence to Zhengfei Zhu.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Informed consent was waived by the institutional review board because this study was retrospective.

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Informed consent was waived by the institutional review board because this study was retrospective.

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This study was approved by the institutional review board at each participating institution.

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Ni, J., Zhou, Y., Wang, S. et al. A brief report on incidence, radiographic feature and prognostic significance of brain MRI changes after anti-PD-1/PD-L1 therapy in advanced non-small cell lung cancer. Cancer Immunol Immunother 71, 1275–1280 (2022). https://doi.org/10.1007/s00262-021-03070-8

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  • DOI: https://doi.org/10.1007/s00262-021-03070-8

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