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Open AccessArticle

Outcome of Patients with NSCLC and Brain Metastases Treated with Immune Checkpoint Inhibitors in a ‘Real-Life’ Setting

1
Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital Section, Karolinska University Hospital, 17164 Stockholm, Sweden
2
Department of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden
3
Department of Medical Oncology, University General Hospital, 71110 Heraklion, Greece
4
Division of Oncology, University of Washington Medical School, Seattle, WA 98195, USA
*
Author to whom correspondence should be addressed.
Equal Contribution.
Cancers 2020, 12(12), 3707; https://doi.org/10.3390/cancers12123707
Received: 15 November 2020 / Revised: 7 December 2020 / Accepted: 8 December 2020 / Published: 10 December 2020
(This article belongs to the Special Issue Brain Metastases (Secondary Brain Tumor))
We identified non-small cell lung cancer (NSCLC) patients with brain metastases who were treated with immune checkpoint inhibitors at Karolinska University Hospital, Sweden and University Hospital of Heraklion, Greece from 2016 to 2019. We analyzed intracranial efficacies in the patients who had not received local treatment for their brain metastases less than three months prior to the initiation of immune checkpoint inhibitors and had adequate radiological evaluation. We demonstrated that immune checkpoint inhibitors are active in NSCLC patients with brain metastases regardless of the presence of neurological symptoms. This is a novel finding since, until now, this patient group has irrefutably been underrepresented in clinical studies and there is a clear scarcity of data. The results of our analyses suggest that symptomatic patients with active brain metastases (BM) may be considered for immunotherapy in routine clinical practice as well as clinical trials.
There is lack of data addressing the intracranial (IC) efficacy of immune checkpoint inhibitors (ICIs) on brain metastases (BM) in non-small cell lung cancer (NSCLC). This patient category is underrepresented in randomized clinical trials. We retrospectively collected clinical data on patients with non-oncogenic driven NSCLC with BM who were treated with ICIs at two medical oncology institutes in Sweden and Greece from 2016 to 2019. IC efficacy was assessed in patients who had not received local treatment for BM less than three months prior to the initiation of ICIs and had adequate radiological evaluation. We screened 280 patients, of which 51 had BM. BM was an independent predictor for inferior PFS (HR = 2.27; 95% CI, 1.53–3.36) but not OS (HR = 1.58; 95% CI, 0.97–2.60) for the whole patient population. IC response assessment was done on 33 patients. IC objective response rate (ORR) was 24.2%. The presence of neurological symptoms related to BM did not affect IC ORR (p = 0.48). High PD-L1 levels from extracranial biopsies were not a predictive factor for IC ORR (p = 0.13). ICIs are active in NSCLC patients with BM regardless of the presence of neurological symptoms and can achieve durable IC disease stabilization in a subgroup of patients. View Full-Text
Keywords: immunotherapy; immune checkpoint inhibitors; advanced lung cancer; non-small cell lung cancer; brain metastases immunotherapy; immune checkpoint inhibitors; advanced lung cancer; non-small cell lung cancer; brain metastases
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MDPI and ACS Style

Skribek, M.; Rounis, K.; Makrakis, D.; Agelaki, S.; Mavroudis, D.; De Petris, L.; Ekman, S.; Tsakonas, G. Outcome of Patients with NSCLC and Brain Metastases Treated with Immune Checkpoint Inhibitors in a ‘Real-Life’ Setting. Cancers 2020, 12, 3707. https://doi.org/10.3390/cancers12123707

AMA Style

Skribek M, Rounis K, Makrakis D, Agelaki S, Mavroudis D, De Petris L, Ekman S, Tsakonas G. Outcome of Patients with NSCLC and Brain Metastases Treated with Immune Checkpoint Inhibitors in a ‘Real-Life’ Setting. Cancers. 2020; 12(12):3707. https://doi.org/10.3390/cancers12123707

Chicago/Turabian Style

Skribek, Marcus; Rounis, Konstantinos; Makrakis, Dimitrios; Agelaki, Sofia; Mavroudis, Dimitris; De Petris, Luigi; Ekman, Simon; Tsakonas, Georgios. 2020. "Outcome of Patients with NSCLC and Brain Metastases Treated with Immune Checkpoint Inhibitors in a ‘Real-Life’ Setting" Cancers 12, no. 12: 3707. https://doi.org/10.3390/cancers12123707

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