Effect and Tolerability of Immunotherapy in Patients with NSCLC with or without Brain Metastasis

• Published in: Cancers Vol. 14; no. 7; p. 1682
• Main Authors: Bjørnhart, Birgitte, Hansen, Karin Holmskov, Asmussen, Jon Thor, Jørgensen, Trine Lembrecht, Herrstedt, Jørn, Schytte, Tine
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 25.03.2022; MDPI
• Subjects: brain metastasis; Cancer therapies; Chemotherapy; clinical trial; Clinical trials; Comorbidity; Immune checkpoint inhibitors; Immunotherapy; Lung cancer; Magnetic resonance imaging; Medical prognosis; Metastases; Metastasis; Neuroimaging; Neurosurgery; non-small cell lung cancer; Non-small cell lung carcinoma; Patients; PD-1/PD-L1 inhibition; Quality of life; Radiation therapy; Small cell lung carcinoma; Tomography; clinical trial; non-small cell lung cancer; PD-1/PD-L1 inhibition; magnetic resonance imaging; screening; prospective study; immunotherapy; survival; brain metastasis; quality of life
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14071682

Sparse data exist on immune checkpoint inhibition (ICI) in NSCLC patients with brain metastasis (BM), especially for those with no local therapy (LT) (whole brain radiation therapy (WBRT), stereotactic RT (SRT) or neurosurgery) preceding ICI. Our aims were to investigate the prevalence of BM, rate of intracranial response (ICR), and survival and quality of life (QoL) in real-life patients with advanced NSCLC undergoing palliative ICI. This was a prospective non-randomized study with magnetic resonance imaging of the brain (MR-C) performed at baseline resulting in a clinical decision to administer LT or not. ICR evaluation (MR-C) at week 8-9 (mRECIST criteria) for group A (LT) and group B (untreated) was assessed. Change in QoL was assessed using EQ-5D-5L. Of 159 included patients, 45 (28%) had baseline BM. Median follow-up was 23.2 months (IQR 16.4-30.2). Of patients in group A (21) and B (16), 16/37 (43%) had symptomatic BM. ICR was 8/21, 38% (complete or partial response) for group A versus 8/16, 50% for group B. No statistical difference in median overall survival of patients with BM (group A: 12.3 (5.2-NR), group B: 20.5 months (4.9-NR)) and without (22.4 months (95% 16.2-26.3)) was obtained. Baseline QoL was comparable regardless of BM, but an improved QoL (at week 9) was found in those without BM. Patients with NSCLC and BM receiving ICI had long-term survival comparable to those without BM.