Combination of Chemotherapy, Immunotherapy, and Radiotherapy for NSCLC With Brain Metastases

By: Vanessa A. Carter, BS
Posted: Monday, January 27, 2025

According to Yun Fan, MD, of Zhejiang Cancer Hospital, Hangzhou, China, and colleagues, brain metastases related to non–small cell lung cancer (NSCLC) have limited therapeutic options and a poor prognosis, despite being a common complication in these patients. To address this treatment gap, these investigators evaluated the efficacy and safety of brain radiotherapy in combination with camrelizumab—an anti–PD-1 monoclonal antibody—and platinum-doublet chemotherapy in this patient population. Their results were published in The Lancet Oncology.

“Overall, the combination of brain radiotherapy with camrelizumab and platinum-doublet chemotherapy shows promising intracranial and systemic efficacy and manageable toxicity and holds potential as a novel option for patients with untreated NSCLC and brain metastases,” the study authors concluded. “Randomized controlled trials are warranted to validate our findings.”

This phase II, single-arm, multicenter trial enrolled 65 adults with newly diagnosed brain metastases from NSCLC who harbored no actionable driver mutations. Participants underwent stereotactic radiosurgery or whole-brain radiotherapy plus camrelizumab and investigator-selected platinum-doublet chemotherapy; patients with nonsquamous NSCLC received pemetrexed, and those with squamous NSCLC received nab-paclitaxel. Maintenance therapy for controlled disease included camrelizumab alone (squamous) or in combination with pemetrexed (nonsquamous).

At the median follow-up of 14.1 months, the 6-month progression-free survival rate was 71.7%, and the median time to intracranial response was 1.9 months. The best mean percentage change in target brain lesions was 68.3%, and the median duration of intracranial response was not reached. The most frequently reported grade 3 or 4 treatment-related adverse events were decreased white blood cell count, lymphocyte count, platelet count, and neutrophil count. Grade 1 to 2 radiation necrosis and grade 3 neurologic toxic effects were reported in three patients each, and no treatment-related deaths were reported.

Disclosure: Dr. Yun Fan reported no conflicts of interest. For full disclosures of the other study authors, visit thelancet.com.

The Lancet Oncology

---