The incidence of meningeal metastases in non-small cell lung cancer is as high as 5%, with limited treatment options and poor prognosis. Can immunotherapy play a role in the treatment of meningeal metastases? Recently, European Journal of Cancer reported a retrospective study from Guangdong Lung Cancer Research Institute. The results showed that 62.5% of patients with meningeal metastases after receiving immunotherapy had their neurological symptoms under control, and a small number of patients benefited long-term, with an overall survival of 4- 5 months , patients with better physical condition lived longer.
3 patients with meningeal metastases who received immunotherapy for more than 20 months
The study included 32 patients with non-small cell lung cancer who received immunotherapy after diagnosis of meningeal metastases, including cases from Guangdong Lung Cancer Research Institute and cases from literature review.
The median age of the patients was 55 years old, 37.5% had -targeted treatment of gene abnormalities, and immunotherapy drugs included nivolumab (O drug, 21 cases), pembrolizumab (K drug, 9 cases) , atezolizumab (9 cases).
Results Neurological symptoms were controlled in 62.5% of patients with meningeal metastases who received immunotherapy. 2 patients had complete response in intracranial and extracranial tumors; 1 patient had partial response in intracranial and extracranial tumors; 1 patient had intracranial tumorPartial response and systemic partial response; 1 patient had CNS tumor partial response and extracranial Tumor unresponsive .
The median progression-free survival (PFS) in the monotherapy group was 2.1 months, and the median overall survival (OS) was 4 months. The median PFS in the combination arm was 3 months, and the median OS was 5.4 months.
htmlThe progression-free survival of 13 patients was more than 20 months, all of them were single -drug immunotherapy, and they all received cranial radiotherapy before immunotherapy, and immunotherapy was used as second-line treatment, of which 2 patients were EGFR/ALK wild-type. Type .
Multivariate analysis showed Better physical status (ECOG PS score) was associated with prolonged PFS, and there was no significant difference in survival between the monotherapy and combination therapy groups.
Immunotherapy can be considered for meningeal metastases
The results of a retrospective study of meningeal metastasesimmune from the Guangdong Lung Cancer Institute were similar to previous similar studies in Europe, the objective response rate of immunotherapy brain metastases, and progression-free survival compared with those without Screened patients without meningeal metastases received similar single-agent immunotherapy, and the response rates were not high, but a small number of patients who responded could have long-term benefits. In terms of overall survival, due to the poor efficacy of follow-up treatment , patients with meningeal metastasis who failed immunotherapy have a short survival time, so the overall survival time is not as good as that of patients without meningeal metastasis.
At present, these retrospective studies suggest that immunotherapy has a certain effect on meningeal metastases and is a salvage treatment option that can be considered. Note) Expand the beneficiary population.
The picture shows the treatment process of patients in the European retrospective study of immunotherapy for meningeal metastases, dark blue is immunotherapy, and the European research suggests Patients with better prognosis of meningeal metastases evaluated according to NCCN guidelines have better immunotherapy effects (patients in green in the picture)
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Reference:
1.Mei-Mei Zheng et al. Clinical outcomes of non–small cell lung cancer patients with leptomeningeal metastases after immune checkpoint inhibitor treatments
DOI:https://doi.org/10.1016/j.ejca.2021.03.037
2 Lizza E.L. Hendriks et al. Survival of patients with non-small cell lung cancer having leptomeningeal metastases treated with immune checkpoint inhibitors.
DOI:https://doi.org/10.1016/j.ejca.2019.05.019
