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SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1513774
Efficacy and safety of immune checkpoint inhibitors for brain metastases of non-small cell lung cancer: A systematic review and network meta-analysis
Provisionally accepted- 1 Hubei Cancer Hospital, Wuhan, Hubei Province, China
- 2 School of Biological Engineering, Wuhan Polytechnic, Wuhan, China
- 3 Zhongnan Hospital, Wuhan University, Wuhan, China
Background: Previous studies have demonstrated that immune checkpoint inhibitors (ICIs) significantly improve prognosis in lung cancer patients with brain metastases (BM). This systematic review and network meta-analysis aim to evaluate the efficacy and safety of ten ICIs recommended by the 2024 Chinese Society of Clinical Oncology guidelines for treating non-small cell lung cancer (NSCLC) without driver genes, with a focus on NSCLC patients presenting with BM. Materials and methods: A comprehensive literature search of PubMed, EMBASE, and the Cochrane Library was conducted through June 2024 to identify eligible controlled trials and head-to-head randomized controlled trials investigating ten ICIs in NSCLC with BM. Pairwise and network meta-analyses were performed using hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs). Treatment efficacy was ranked hierarchically through the Surface Under the Cumulative Ranking Curve (SUCRA). Results: Sixteen trials from 11 studies, encompassing 1,274 NSCLC patients with BM, were included. Meta-analysis demonstrated that ICIs significantly improved overall survival (OS: HR, 0.66; 95%CI, 0.52–0.85, P=0.001) and progression-free survival (PFS: HR, 0.67; 95%CI, 0.54–0.84, P<0.001). SUCRA ranking identified pembrolizumab as the most effective agent for OS improvement (SUCRA 71%), while camrelizumab showed superior PFS benefits (SUCRA 92%). ICIs were associated with increased objective response rates (RR: 1.52; 95%CI: 1.13–2.06; P=0.006), but elevated risks of immune-mediated adverse events (RR: 2.50; 95%CI: 1.46–4.30; P=0.001), and grades 3-5 immune-mediated adverse events and infusion reaction (RR: 6.39; 95%CI: 1.53–26.69; P=0.011). Conclusion: ICIs demonstrate superior survival benefits compared to chemotherapy in NSCLC patients with BM, with pembrolizumab and camrelizumab emerging as optimal choices for OS and PFS improvement, respectively. However, vigilant monitoring of immune-mediated adverse events and infusion reactions remains critical in clinical practice.
Keywords: immune checkpoint inhibitors, Non-small cell lung cancer, brain metastases, Systematic review, Network meta-analysis
Received: 19 Oct 2024; Accepted: 26 Mar 2025.
Copyright: © 2025 Bin, Chen and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Mingqi Luo, Zhongnan Hospital, Wuhan University, Wuhan, China
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