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Page 6 of 8 Niu et al. Neuroimmunol Neuroinflammation 2018;5:32 I http://dx.doi.org/10.20517/2347-8659.2018.39

notherapy in NSCLC with BM. However, as aforementioned, the Checkmate 227 study exhibited great activ-
[28]
ity of nivolumab-ipilimumab combination against NSCLC with high TMB . Extrapolating from melanoma
studies, it is conceivable that the same combination might be able to confer a much higher and more durable
response in NSCLC with BM and high TMB. In the Keynote 189 trial using platinum/pemetrexed/pembroli-
zumab, the hazard ratio in the subgroup of 108 patients with BM was impressive 0.36, suggesting chemo-im-
[26]
munotherapy could represent an effective option for this group, although PDL1 status was unknown . For
[26]
the PD-L1 ≥ 50% subgroup, the RR was over 60%, with a disease control rate almost up to 90% . This treat-
ment combination might also provide a great ICRR and durable IC PFS given that both chemotherapy and
immunotherapy have been shown to be effective against BM in NSCLC. Furthermore, how to incorporate
and/or sequence SRS in the context of immunotherapy remains unanswered. Prospective studies are needed
to address these burning questions, and future adoption of immunotherapy or immunotherapy combina-
tions as the first-line therapy in the appropriate patient population with BM may change our current clinical
practice and the use of WBRT or SRT.

DECLARATIONS
Authors’ contributions
Design: Niu J
Literature research, data analysis, manuscript writing and editing: Niu J, Zhou J, Lindebak S, Mahmoud F
Manuscript revision: Niu J

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

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