Mind control.

How effective are immune checkpoint inhibitors (ICI) for brain metastases in patients with non-small cell lung cancer (NSCLC)? In this phase 2, single institution trial, 42 patients with asymptomatic brain mets between 5 mm and 2 cm were treated with initial pembrolizumab alone without radiation. The brain mets had to have been untreated (50%) or progressing after prior radiation therapy. The majority of patients (88%) had PD-L1 expression of at least 1%. Overall, 11 patients (26%) had an intracranial response. All responses occurred within the first 12 weeks of treatment and all were in PD-L1 (+) patients.  A third of these patients remained free from intracranial progression at 1 year. TBL: Pembrolizumab has a 26% (30% if PD-L1 +) intracranial response rate in patients with untreated or progressing brain mets from NSCLC. | Goldberg, Lancet Oncol 2020