Brain metastases (BM) are a frequent and severe complication in patients with lung cancer, breast cancer, and melanoma. Immune checkpoint inhibitors (ICIs) have become a crucial treatment option for BM, whether used alone or in combination with chemotherapy and stereotactic radiosurgery (SRS). However, ICIs are associated with immune-related adverse events (irAEs) that can affect multiple organ systems, complicating their use in BM patients. This review examines the mechanisms of irAEs and their effects on different organs and evaluates the safety of ICIs across various treatment strategies for BM. Our analysis indicates that ICIs significantly improve survival and disease control in BM patients, but their use increases the risk of irAEs, including dermatologic, gastrointestinal, endocrine, pulmonary, and neurologic toxicities. Neurotoxic events, particularly treatment-associated brain necrosis (TABN) and encephalitis, are more common in BM patients. While the overall incidence of irAEs is similar between patients with and without BM, the neurotoxicity risk is higher in the BM population. Combining ICIs with chemotherapy and SRS enhances efficacy but also heightens the risk of adverse events across organ systems. ICIs offer substantial benefits for BM patients but require careful management to mitigate the risks of irAEs. Close patient monitoring, individualized treatment protocols, and prompt intervention are essential for optimizing the outcomes. Future research should focus on refining combination strategies and improving the management of irAEs, particularly neurotoxicity, to maximize therapeutic benefits for BM patients.
脑转移是肺癌、乳腺癌和黑色素瘤患者常见且严重的并发症。免疫检查点抑制剂已成为脑转移的重要治疗选择，无论是单独使用还是与化疗及立体定向放射外科联合应用。然而，免疫检查点抑制剂可能引发累及多器官系统的免疫相关不良事件，使其在脑转移患者中的应用复杂化。本综述探讨了免疫相关不良事件的发生机制及其对不同器官的影响，并评估了免疫检查点抑制剂在脑转移各种治疗策略中的安全性。分析表明，免疫检查点抑制剂能显著改善脑转移患者的生存率和疾病控制率，但会增加免疫相关不良事件风险，包括皮肤、胃肠道、内分泌、肺部和神经系统毒性。神经毒性事件，特别是治疗相关脑坏死和脑炎，在脑转移患者中更为常见。虽然脑转移与非脑转移患者的免疫相关不良事件总体发生率相似，但脑转移人群的神经毒性风险更高。免疫检查点抑制剂与化疗及立体定向放射外科联合治疗可增强疗效，但也会增加各器官系统不良事件风险。免疫检查点抑制剂为脑转移患者带来显著获益，但需要精细管理以降低免疫相关不良事件风险。密切的患者监测、个体化治疗方案和及时干预对优化治疗效果至关重要。未来研究应着重完善联合治疗策略，改进免疫相关不良事件特别是神经毒性的管理，以最大化脑转移患者的治疗获益。
肿瘤(癌症)患者之家