肺癌和黑色素瘤的中枢神经系统（CNS）转移显着增加发病率和死亡率。尽管局部治疗取得了进展，但仍然需要有效的全身治疗。 Pembrolizumab 是一种 PD-1 抑制剂，对一些未经治疗的黑色素瘤和非小细胞肺癌 (NSCLC) 脑转移患者显示出希望。本研究旨在分析脑转移瘤对 pembrolizumab 的反应，并将大小和位置等特征与治疗结果相关联。这项回顾性研究使用了 pembrolizumab 在未经治疗的脑转移的黑色素瘤或 NSCLC 患者中进行的 II 期试验的影像数据。每隔 2 个月进行一次 MRI 评估，根据修改后的 RECIST 标准（最多 5 个病灶，5 mm 目标病灶），将每个脑转移瘤视为不同的肿瘤进行疗效评估。在 130 个个体目标转移瘤（> 5 mm）中， 65 名 NSCLC（90 个转移瘤）和黑色素瘤（40 个转移瘤）患者中，32 名（24.6%）显示完全消退，24 名（18.5%）显示部分消退，32 名（24.6%）显示 SD，42 名（32.3%）显示 PD。 那些小于 10 毫米的人更有可能显示出完整的分辨率 (p = 0.0218)，而那些 ≥ 10 毫米的人更有可能出现 PR。 大小、数量或位置（幕上与幕下）与病变进展之间没有显着关联。脑转移病灶进展的中位时间为 5.7-7 周。派姆单抗对 NSCLC 和黑色素瘤脑转移有效，43% 的转移灶出现缓解 (CR  PR)，32% 的转移灶出现进展 (PD)。中枢神经系统进展的中位时间为 5.7-7 周，仔细的放射学监测对于指导及时的局部治疗决策至关重要。© 2024。作者获得 Springer Science Business Media, LLC（Springer Nature 的一部分）的独家许可。

Central nervous system (CNS) metastases from lung cancers and melanoma, significantly contribute to morbidity and mortality. Despite advances in local therapies, there is a need for effective systemic treatments. Pembrolizumab, a PD-1 inhibitor, has shown promise for some patients with untreated brain metastases from melanoma and non-small cell lung cancer (NSCLC). This study aims to analyze the response of brain metastasis to pembrolizumab and associate characteristics like size and location with treatment outcome.This retrospective study used imaging data from a phase II trial of pembrolizumab in melanoma or NSCLC patients with untreated brain metastases. MRI evaluations were conducted at 2 month intervals, with each brain metastasis treated as a distinct tumor for response assessment, based on modified RECIST criteria (maximum 5 lesions, 5 mm target lesions).Of 130 individual target metastases (> 5 mm), in 65 patients with NSCLC (90 metastases) and Melanoma (40 metastases), 32 (24.6%) demonstrated complete resolution, 24 (18.5%) had partial resolution, 32 (24.6%) were SD and 42 (32.3%) demonstrated PD. Those smaller than 10 mm were more likely to show complete resolution (p = 0.0218), while those ≥ 10 mm were more likely to have PR. There was no significant association between size, number or location (supratentorial vs. infratentorial) and lesion progression. The median time to metastatic lesion progression in the brain was 5.7-7 weeks.Pembrolizumab is effective in brain metastases from NSCLC and melanoma, showing response (CR + PR) in 43% and progression (PD) in 32% of metastases. With the median time to CNS progression of 5.7-7 weeks, careful radiographic monitoring is essential to guide timely local treatment decisions.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.