Therapeutic strategies in these patients should be individualized based on their clinical characteristics. These results could help clinicians to select an optimal combination strategy for NSCLC patients with BM.What are the implications, and what should change now? Our study improves the understanding of different treatments in NSCLC patients with BM, suggesting that ICI-based therapies have potential clinical value for BM.
CHECKMATE 9LA BRAIN METASTASES DRIVER
There is an ongoing concern and debate about the optimal therapies for BM patients with negative driver genes.In particular, patients who received first-line treatment or were programmed death-ligand 1 (PD-L1)-positive could benefit more from ICIs. Our study found that non-small cell lung cancer (NSCLC) patients with brain metastases (BM) who received immune checkpoint inhibitor (ICI)-based therapies achieved an impressive intracerebral objective response rate (icORR) and long-term survival benefit.These innovative findings could help clinicians to better select therapeutic strategies for NSCLC patients with BM.
CHECKMATE 9LA BRAIN METASTASES PLUS
For patients with a PD-L1-negative status, chemotherapy plus RT led to better clinical outcomes than other treatment regimens. In particular, patients who received first-line treatment or who were PD-L1-positive had a more significant survival benefit from aggressive ICI-based therapies. Notably, the subgroup analysis indicated that the pooled icORR of patients in programmed cell death-ligand 1 (PD-L1) (≥50%) who received ICI was 54% (95% CI: 30–77%), and that of patients who received first-line ICI was 69.0% (95% CI: 51–85%).Ĭonclusions: ICI-based combination treatment provides a long-term survival benefit for non-targeted therapy patients, with the most significant benefits observed in improving icORR and prolonging overall survival (OS) and iPFS. ICI plus chemotherapy also showed potent antitumor activity in BM, with a pooled icORR of 56% (95% CI: 29–82%) and a median iPFS of 6.9 months (95% CI: 3.20–10.60 months). The highest median iPFS in nivolumab plus ipilimumab plus chemotherapy was 13.5 months (95% CI: 8.35–18.65 months). The pooled icORR and median iPFS of RT plus chemotherapy were 46% (95% CI: 34–57%) and 5.7 months (95% CI: 3.90–7.50 months), respectively. Antitumor agents plus radiotherapy (RT) showed the most significant synergistic effects the highest pooled icORR that appeared in the combination of immune checkpoint inhibitor (ICI) and RT was 81%, and the median iPFS was 7.04 months (95% CI: 2.54–11.55 months). Results: Thirty-six studies involving 1,774 NSCLC patients with baseline BM were included in this meta-analysis. The primary endpoints included the intracerebral objective response rate (icORR) and intracerebral progression-free survival (iPFS) in patients with BM. Methods: A comprehensive search was conducted in databases including PubMed, Embase, and the Cochrane Library. Therefore, we conducted a meta-analysis to investigate the potential benefit of different therapeutic regimens for intracranial lesions in non-targeted therapy NSCLC patients. #These authors contributed equally to this work.īackground: As one of the most common causes of death in advanced non-small cell lung cancer (NSCLC), brain metastases (BM) have attracted attention and debate about treatment options, especially for patients with negative driver genes or resistance to targeted agents. Mo Chen 1#, Lingyun Wei 2#, Qin Wang 3#, Jingyuan Xie 3, Ke Xu 3, Tangfeng Lv 1,3,4, Yong Song 1,3,4, Ping Zhan 1,3,4ġ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China Ģ Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China ģ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China Ĥ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, ChinaĬontributions: (I) Conception and design: M Chen, P Zhan (II) Administrative support: T Lv, Y Song (III) Provision of study materials or patients: All authors (IV) Collection and assembly of data: M Chen, L Wei, Q Wang (V) Data analysis and interpretation: M Chen, P Zhan (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.
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