Lung cancer remains a severe malignancy, expected to account for over 125,000 deaths in 2024. With high rates of mortality in both males and females, lung cancer accounts for more cancer-related deaths than any other malignancy.
Advanced cases of lung cancer can metastasize to the brain, and about 20% of patients have brain metastases when diagnosed. Non-small cell lung cancer (NSCLC) represents a highly aggressive subtype of lung cancer, accounting for over 80% of lung cancer cases. As NSCLC skews towards late-stage diagnoses, five-year survival rates remain around 20%.
Approximately 30 – 50% of NSCLC patients experience brain metastasis. Due to the complexity of finding feasible therapies to reach cancer cells in the brain, NSCLC with brain metastasis presents significant clinical challenges. In addition, brain metastasis can hinder quality of life and negatively impact survivorship.
Immune checkpoint inhibitors (ICIs), a breakthrough in cancer treatment, have provided novel treatment options for stage IV NSCLC patients over the past several years. Despite the promise of these therapies, scientists and oncologists have not yet fully optimized ICI therapeutic regimens.
A new case study published in Oncosciene details a patient who experienced a notable response to ICI therapy. The patient, a 51-year-old man with stage IV NSCLC with brain metastasis, received whole-brain radiation followed by chemotherapy. Initially, the treatment regimen induced a partial response characterized by a lung tumor size reduction. Additional lesions appeared on the liver, and although these areas could not undergo biopsy, doctors suspected that additional metastatic lesions arose in the liver. The lesions in the brain experienced a complete response, which the patient maintained despite progression in the liver.
As a second-line treatment, the patient received pembrolizumab, an ICI that targets programmed death-1 (PD-1), a checkpoint located on immune cells. After three treatment cycles, the patient experienced a partial response in the liver and stable disease in the lung. By the sixth cycle of treatment, the patient had a complete response in the liver and a partial response in the lung. In addition, a complete response occurred on the brain lesions. The lesion in the lung continued to shrink, leading to a complete response in all three regions (liver, lung, brain).
Through 53 cycles of ICI, the patient maintained a complete response with only one minor adverse event, a grade 1 skin rash. The patient recently had a follow-up appointment 26 months after his last treatment. At this appointment, doctors noted the patient had no symptoms, no evidence of disease, and an excellent quality of life. Since diagnosis, the patient has reached 87 months of overall survival (OS) and 73 months of progression-free survival (PFS).
While the study presents just a single case of NSCLC, the results are promising. The researchers suggest that sequencing the regimen with radiation followed by ICI could present an optimal strategy for administering treatment. While more work is needed, the study provides new insight into ways to optimize the benefits of ICI therapy for a vulnerable cohort of patients.
Sources: CA Caner J Cln, Annals Oncol, Oncosci