Background: Brain metastases (BM) are a common, severe complication in patients with non-small cell lung cancer (NSCLC) and are difficult to treat due to their complex tumor biology and the intricate microenvironment of the brain. Objectives: This review examines the current role of immune checkpoint inhibitors (ICIs) in treating NSCLC with BM, focusing on the latest clinical trials, emerging strategies, current guidelines, and future directions. We highlight the efficacy of ICIs as monotherapy and in combination with other treatments such as radiotherapy, stereotactic radiosurgery, chemotherapy, and anti-VEGF agents. Results: While no single treatment sequence is universally accepted, combining ICIs with traditional therapies forms the core of the current treatment protocols. ICIs targeting the PD-1/PD-L1 pathway have significantly advanced NSCLC treatment, demonstrated by improved overall and progression-free survival in various settings. However, optimizing these benefits requires careful consideration of potential side effects, including cognitive decline and radiation necrosis, and the impact of steroid use on ICI efficacy. Conclusion: The review underscores the necessity for a personalized, integrated multidisciplinary treatment approach. Future research should focus on refining combination therapies and understanding the optimal sequence and timing of treatment.
背景：脑转移是非小细胞肺癌患者常见且严重的并发症，因其复杂的肿瘤生物学特性及脑部微环境而难以治疗。目的：本综述探讨免疫检查点抑制剂在治疗伴脑转移的非小细胞肺癌中的当前作用，重点关注最新临床试验、新兴策略、现行指南及未来方向。我们着重分析免疫检查点抑制剂作为单药治疗，以及与放疗、立体定向放射外科、化疗和抗血管内皮生长因子药物等其他疗法联合应用的疗效。结果：尽管目前尚无公认的统一治疗顺序，但免疫检查点抑制剂与传统疗法的联合应用构成了当前治疗方案的核心。靶向PD-1/PD-L1通路的免疫检查点抑制剂显著推进了非小细胞肺癌的治疗，多项研究显示其在改善患者总生存期和无进展生存期方面具有显著效果。然而，要优化这些益处，需审慎考量潜在副作用（包括认知功能下降和放射性坏死）以及类固醇使用对免疫检查点抑制剂疗效的影响。结论：本综述强调了个性化、整合性多学科治疗方法的必要性。未来研究应聚焦于优化联合治疗方案，并深入探讨治疗的最佳顺序与时机。
肿瘤(癌症)患者之家