Abstract
With the advancement of imaging technology, systemic disease control rate and survival rate, the morbidity of brain metastases (BMs) from non-small cell lung cancer (NSCLC) has been riding on a steady upward trend (40%), but management of BMs from NSCLC remains obscure. Systemic therapy is anticipated to offer novel therapeutic avenues in the management of NSCLC BMs, and radiotherapy (RT) and immunotherapy have their own advantages. Recently, it was confirmed that immune checkpoint inhibitors (ICIs) and RT could mutually promote the efficacy in the treatment of BMs from NSCLC. In this paper, we provide a review on current understandings and practices of separating or combining ICIs and RT, which could provide a reference for the coming laboratory and clinical studies and contribute to the development of new approaches in NSCLC BMs.
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Abbreviations
- NSCLC:
-
Non-small cell lung cancer
- BMs:
-
Brain metastases
- DCR:
-
Disease control rate
- SRS–SRT:
-
Stereotactic radiosurgery–stereotactic radiotherapy
- BBB:
-
Blood–brain barrier
- WBRT:
-
Whole brain radiotherapy
- EGFR:
-
Epidermal growth factor receptors
- ALK:
-
Anaplastic lymphoma kinase
- TKIs:
-
Tyrosine kinase inhibitors
- CNS:
-
Central nervous system
- RRs:
-
Response rates
- OS:
-
Overall survival
- RT:
-
Radiotherapy
- ICIs:
-
Immune checkpoint inhibitors
- RN:
-
Radiation necrosis
- LR:
-
Local recurrence
- TCP:
-
Tumor control
- HFSRT:
-
Hypofractionated stereotactic radiation therapy
- PS:
-
Performance status
- HR:
-
Hazard ratio
- RCT:
-
Randomized controlled studies
- LMC:
-
Leptomeningeal carcinomatosis
- HVLT-R DR:
-
Hopkins Verbal Learning Test-Revised Delayed Recall
- HS-WBRT:
-
Hippocampal-sparing whole brain radiotherapy
- RTOG:
-
Radiation Therapy Oncology Group
- QOL:
-
Quality-of-life
- EORTC:
-
European Organization for Research and Treatment of Cancer
- BTR:
-
Brain tumor recurrence
- TME:
-
Tumor microenvironment
- ECM:
-
Extracellular matrix
- APC:
-
Antigen-presenting cell
- PD-1:
-
Programmed cell death-1
- PD-L1:
-
Programmed cell death-ligand 1
- CTLA-4:
-
Cytotoxic T-lymphocyte-associated antigen-4
- TILs:
-
Tumor-infiltrating lymphocytes
- PR:
-
Partial response
- SD:
-
Stable disease
- PD:
-
Progressive disease
- IORR:
-
Intracerebral objective response rate
- PFS:
-
Progression-free survival
- AEs:
-
Adverse events
- Tregs:
-
Regulatory T cells
- Anti-CTLA-4:
-
CTLA-4-blocking antibody
- 18F-FDG PET/CT:
-
18F-flurodeoxyglucose positron emission tomography/computed tomography
- IF:
-
In-fields
- KM:
-
Kaplan–Meier
- RCC:
-
Renal cell carcinoma
- RICT:
-
Radiation-induced cardiotoxicity
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We thank all the members of Radiation Oncology Department of Thoracic Cancer for kind support.
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This work was supported by the National Natural Science Foundation of Liaoning (2015020263).
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WL and HY designed and wrote the paper; WL collected and read the references, and made the figures and tables.
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Li, W., Yu, H. Separating or combining immune checkpoint inhibitors (ICIs) and radiotherapy in the treatment of NSCLC brain metastases. J Cancer Res Clin Oncol 146, 137–152 (2020). https://doi.org/10.1007/s00432-019-03094-9
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DOI: https://doi.org/10.1007/s00432-019-03094-9