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Emergent immunotherapy approaches for brain metastases
Brain metastases from solid tumors are increasing in incidence, especially as outcomes of systemic therapies continue to extend patients’ overall survival. The long-held notion that the brain is an immune sanctuary has now been largely refuted with increasing evidence that immunotherapy can induce d...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633738/ https://www.ncbi.nlm.nih.gov/pubmed/34859232 http://dx.doi.org/10.1093/noajnl/vdab138 |
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author | Wang, Jianbo Tawbi, Hussein A |
author_facet | Wang, Jianbo Tawbi, Hussein A |
author_sort | Wang, Jianbo |
collection | PubMed |
description | Brain metastases from solid tumors are increasing in incidence, especially as outcomes of systemic therapies continue to extend patients’ overall survival. The long-held notion that the brain is an immune sanctuary has now been largely refuted with increasing evidence that immunotherapy can induce durable responses in brain metastases. Single agent immune checkpoint inhibition with anti-CTLA4 and anti-PD1 antibodies induces durable responses in 15%–20% in melanoma brain metastases as long as patients are asymptomatic and do not require corticosteroids. The combination of anti-CTLA4 with anti-PD-1 antibodies induces an intracranial response in over 50% of asymptomatic melanoma patients, and much lower rate of otherwise durable responses (20%) in symptomatic patients or those on steroids. Data in other cancers, such as renal cell carcinoma, are accumulating indicating a role for immunotherapy. Emerging immunotherapy approaches will have to focus on increasing response rates, decreasing toxicity, and decreasing steroid dependency. The path to those advances will have to include a better understanding of the mechanisms of response and resistance to immunotherapy in brain metastases, the use of novel agents such as anti-LAG3 checkpoint inhibitors, targeted therapy (oncogene directed or TKIs), and possibly surgery and SRS to improve the outcomes of patients with brain metastases. |
format | Online Article Text |
id | pubmed-8633738 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-86337382021-12-01 Emergent immunotherapy approaches for brain metastases Wang, Jianbo Tawbi, Hussein A Neurooncol Adv Supplement Articles Brain metastases from solid tumors are increasing in incidence, especially as outcomes of systemic therapies continue to extend patients’ overall survival. The long-held notion that the brain is an immune sanctuary has now been largely refuted with increasing evidence that immunotherapy can induce durable responses in brain metastases. Single agent immune checkpoint inhibition with anti-CTLA4 and anti-PD1 antibodies induces durable responses in 15%–20% in melanoma brain metastases as long as patients are asymptomatic and do not require corticosteroids. The combination of anti-CTLA4 with anti-PD-1 antibodies induces an intracranial response in over 50% of asymptomatic melanoma patients, and much lower rate of otherwise durable responses (20%) in symptomatic patients or those on steroids. Data in other cancers, such as renal cell carcinoma, are accumulating indicating a role for immunotherapy. Emerging immunotherapy approaches will have to focus on increasing response rates, decreasing toxicity, and decreasing steroid dependency. The path to those advances will have to include a better understanding of the mechanisms of response and resistance to immunotherapy in brain metastases, the use of novel agents such as anti-LAG3 checkpoint inhibitors, targeted therapy (oncogene directed or TKIs), and possibly surgery and SRS to improve the outcomes of patients with brain metastases. Oxford University Press 2021-11-27 /pmc/articles/PMC8633738/ /pubmed/34859232 http://dx.doi.org/10.1093/noajnl/vdab138 Text en © The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Supplement Articles Wang, Jianbo Tawbi, Hussein A Emergent immunotherapy approaches for brain metastases |
title | Emergent immunotherapy approaches for brain metastases |
title_full | Emergent immunotherapy approaches for brain metastases |
title_fullStr | Emergent immunotherapy approaches for brain metastases |
title_full_unstemmed | Emergent immunotherapy approaches for brain metastases |
title_short | Emergent immunotherapy approaches for brain metastases |
title_sort | emergent immunotherapy approaches for brain metastases |
topic | Supplement Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633738/ https://www.ncbi.nlm.nih.gov/pubmed/34859232 http://dx.doi.org/10.1093/noajnl/vdab138 |
work_keys_str_mv | AT wangjianbo emergentimmunotherapyapproachesforbrainmetastases AT tawbihusseina emergentimmunotherapyapproachesforbrainmetastases |