In the era of immune checkpoint inhibitors (ICI), managing non-oncogene driven non-small cell lung cancer (NSCLC) with brain metastases (BM) is challenging, especially when brain involvement is the initial sign. Patients with newly diagnosed brain metastatic NSCLC without epidermal growth factor receptor (EFGR) nor anaplastic lymphoma kinase (ALK) alterations were retrospectively included. Twenty-five patients were analyzed; 15 (60%) had symptomatic BM as the first sign (group 1), while 10 (40%) had BM discovered during complementary examinations (group 2). Fourteen patients (56%) had concomitant extracerebral metastases, primarily in group 2. Eight (32%) had oligometastatic disease, with seven in group 1. Over half received chemotherapy and pembrolizumab as first-line treatment. BM surgical resection occurred in twelve (80%) patients in group 1 and one in group 2. Median cerebral progression-free survival was 10 months: 12 in group 1 and 5 in group 2. Median overall survival was 25 months: not reached in group 1 and 6 months in group 2. This case series highlights survival outcomes for patients with inaugural BM, a demographic underrepresented in pivotal trials. Oligometastatic disease and symptomatic BM as initial signs seem associated with better prognosis due to increased use of multimodal local approaches. Combining local approaches with first-line ICI+/− chemotherapy appears to improve survival in brain metastatic NSCLC. A literature review was conducted to explore key questions regarding upfront ICI alone or in combination with systemic drugs or local approaches in brain metastatic NSCLC.
在免疫检查点抑制剂（ICI）时代，治疗非致癌基因驱动的非小细胞肺癌（NSCLC）伴脑转移（BM）具有挑战性，尤其当脑部受累为首发表现时。本研究回顾性纳入了新诊断脑转移NSCLC且无表皮生长因子受体（EGFR）或间变性淋巴瘤激酶（ALK）基因突变的患者。共分析25例患者：15例（60%）以症状性脑转移为首发表现（第1组），10例（40%）在补充检查中发现脑转移（第2组）。14例（56%）伴有颅外转移，主要集中于第2组。8例（32%）为寡转移性疾病，其中7例属于第1组。超过半数患者接受化疗联合帕博利珠单抗作为一线治疗。脑转移手术切除在第1组12例（80%）及第2组1例患者中实施。中位脑部无进展生存期为10个月：第1组12个月，第2组5个月。中位总生存期为25个月：第1组未达到，第2组为6个月。本病例系列研究揭示了以脑转移为首发表现患者的生存结局，该人群在关键临床试验中代表性不足。寡转移性疾病及症状性脑转移作为初始表现似乎与更好的预后相关，这可能得益于多模式局部治疗手段的更多应用。局部治疗联合一线ICI±化疗似乎能改善脑转移NSCLC患者的生存。本文通过文献综述，探讨了脑转移NSCLC治疗中关于单独使用前期ICI、或联合全身药物及局部治疗方案的核心问题。
肿瘤(癌症)患者之家