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Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases

Immunotherapy has now been integrated as a treatment strategy for most patients with non-small cell lung cancer (NSCLC). However, the pivotal clinical trials that demonstrated its impressive efficacy often did not include patients with active, untreated brain metastases or leptomeningeal carcinomato...

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Autores principales: Pierret, Thomas, Giaj-Levra, Niccolò, Toffart, Anne-Claire, Alongi, Filippo, Moro-Sibilot, Denis, Gobbini, Elisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039308/
https://www.ncbi.nlm.nih.gov/pubmed/35494085
http://dx.doi.org/10.3389/fonc.2022.787080
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author Pierret, Thomas
Giaj-Levra, Niccolò
Toffart, Anne-Claire
Alongi, Filippo
Moro-Sibilot, Denis
Gobbini, Elisa
author_facet Pierret, Thomas
Giaj-Levra, Niccolò
Toffart, Anne-Claire
Alongi, Filippo
Moro-Sibilot, Denis
Gobbini, Elisa
author_sort Pierret, Thomas
collection PubMed
description Immunotherapy has now been integrated as a treatment strategy for most patients with non-small cell lung cancer (NSCLC). However, the pivotal clinical trials that demonstrated its impressive efficacy often did not include patients with active, untreated brain metastases or leptomeningeal carcinomatosis. Nevertheless, NSCLC is the most common tumor to metastasize to the brain, and patients develop brain and meningeal involvement in approximately 40 and 10% of cases, respectively. Consequently, the appropriate care of these patients is a recurrent clinical concern. Although there are many aspects that would merit further investigation to explain the mechanism of intracranial response to immune checkpoint inhibitors (ICPs), some data suggest that they are able to cross the blood–brain barrier, resulting in local tumor microenvironment modification. This results in a similar clinical benefit in patients with stable, previously treated brain metastases compared to the general population. Despite important limitations, some real-life studies have described that the ICPs’ efficacy was maintained also in less selected patients with untreated or symptomatic brain metastases. In contrast, few data are available about patients with leptomeningeal carcinomatosis. Nevertheless, neurological complications due to ICP treatment in patients with brain metastases have to be evaluated and carefully monitored. Despite the fact that limited data are available in the literature, the purpose of this review is to show that the multimodal treatment of these patients with brain metastases and/or leptomeningeal disease should be discussed during tracing of the history of the disease, participating in the local and possibly systemic control of NSCLC.
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spelling pubmed-90393082022-04-27 Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases Pierret, Thomas Giaj-Levra, Niccolò Toffart, Anne-Claire Alongi, Filippo Moro-Sibilot, Denis Gobbini, Elisa Front Oncol Oncology Immunotherapy has now been integrated as a treatment strategy for most patients with non-small cell lung cancer (NSCLC). However, the pivotal clinical trials that demonstrated its impressive efficacy often did not include patients with active, untreated brain metastases or leptomeningeal carcinomatosis. Nevertheless, NSCLC is the most common tumor to metastasize to the brain, and patients develop brain and meningeal involvement in approximately 40 and 10% of cases, respectively. Consequently, the appropriate care of these patients is a recurrent clinical concern. Although there are many aspects that would merit further investigation to explain the mechanism of intracranial response to immune checkpoint inhibitors (ICPs), some data suggest that they are able to cross the blood–brain barrier, resulting in local tumor microenvironment modification. This results in a similar clinical benefit in patients with stable, previously treated brain metastases compared to the general population. Despite important limitations, some real-life studies have described that the ICPs’ efficacy was maintained also in less selected patients with untreated or symptomatic brain metastases. In contrast, few data are available about patients with leptomeningeal carcinomatosis. Nevertheless, neurological complications due to ICP treatment in patients with brain metastases have to be evaluated and carefully monitored. Despite the fact that limited data are available in the literature, the purpose of this review is to show that the multimodal treatment of these patients with brain metastases and/or leptomeningeal disease should be discussed during tracing of the history of the disease, participating in the local and possibly systemic control of NSCLC. Frontiers Media S.A. 2022-04-12 /pmc/articles/PMC9039308/ /pubmed/35494085 http://dx.doi.org/10.3389/fonc.2022.787080 Text en Copyright © 2022 Pierret, Giaj-Levra, Toffart, Alongi, Moro-Sibilot and Gobbini https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Pierret, Thomas
Giaj-Levra, Niccolò
Toffart, Anne-Claire
Alongi, Filippo
Moro-Sibilot, Denis
Gobbini, Elisa
Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title_full Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title_fullStr Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title_full_unstemmed Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title_short Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases
title_sort immunotherapy in nsclc patients with brain and leptomeningeal metastases
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039308/
https://www.ncbi.nlm.nih.gov/pubmed/35494085
http://dx.doi.org/10.3389/fonc.2022.787080
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