Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions

Brain metastases (BMs) are a relatively common and severe complication in advanced non-small cell lung cancer (NSCLC), significantly affecting patient prognosis. Metastatic tumor cells can alter the brain tumor microenvironment (TME) to promote an immunosuppressive state, characterized by reduced in...

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Main Authors: Meng Wang, Jihua Yang, Shuai Wang, Harjot Gill, Haiying Cheng
Format: Article
Language:English
Published: MDPI AG 2025-03-01
Series:Current Oncology
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Online Access:https://www.mdpi.com/1718-7729/32/3/171
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author Meng Wang
Jihua Yang
Shuai Wang
Harjot Gill
Haiying Cheng
author_facet Meng Wang
Jihua Yang
Shuai Wang
Harjot Gill
Haiying Cheng
author_sort Meng Wang
collection DOAJ
description Brain metastases (BMs) are a relatively common and severe complication in advanced non-small cell lung cancer (NSCLC), significantly affecting patient prognosis. Metastatic tumor cells can alter the brain tumor microenvironment (TME) to promote an immunosuppressive state, characterized by reduced infiltration of tumor-infiltrating lymphocytes (TILs), diminished expression of programmed death-ligand 1 (PD-L1), and changes in other proinflammatory factors and immune cell populations. Microglia, the resident macrophages of the brain, play a pivotal role in modulating the central nervous system (CNS) microenvironment through interactions with metastatic cancer cells, astrocytes, and infiltrating T cells. The M2 phenotype of microglia contributes to immunosuppression in BM via the activation of signaling pathways such as STAT3 and PI3K-AKT-mTOR. Recent advances have enhanced our understanding of the immune landscape of BMs in NSCLC, particularly regarding immune evasion within the CNS. Current immunotherapeutic strategies, including immune checkpoint inhibitors, have shown promise for NSCLC patients with BM, demonstrating intracranial activity and manageable safety profiles. Future research is warranted to further explore the molecular and immune mechanisms underlying BM, aiming to develop more effective treatments.
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spelling doaj-art-e077003b4aed43918a8d1bd77a0eb5032025-08-20T03:43:30ZengMDPI AGCurrent Oncology1198-00521718-77292025-03-0132317110.3390/curroncol32030171Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future DirectionsMeng Wang0Jihua Yang1Shuai Wang2Harjot Gill3Haiying Cheng4Department of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USADepartment of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USADepartment of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USADepartment of Pathology, Montefiore Medical Center, Bronx, NY 10461, USADepartment of Oncology (Medical Oncology), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USABrain metastases (BMs) are a relatively common and severe complication in advanced non-small cell lung cancer (NSCLC), significantly affecting patient prognosis. Metastatic tumor cells can alter the brain tumor microenvironment (TME) to promote an immunosuppressive state, characterized by reduced infiltration of tumor-infiltrating lymphocytes (TILs), diminished expression of programmed death-ligand 1 (PD-L1), and changes in other proinflammatory factors and immune cell populations. Microglia, the resident macrophages of the brain, play a pivotal role in modulating the central nervous system (CNS) microenvironment through interactions with metastatic cancer cells, astrocytes, and infiltrating T cells. The M2 phenotype of microglia contributes to immunosuppression in BM via the activation of signaling pathways such as STAT3 and PI3K-AKT-mTOR. Recent advances have enhanced our understanding of the immune landscape of BMs in NSCLC, particularly regarding immune evasion within the CNS. Current immunotherapeutic strategies, including immune checkpoint inhibitors, have shown promise for NSCLC patients with BM, demonstrating intracranial activity and manageable safety profiles. Future research is warranted to further explore the molecular and immune mechanisms underlying BM, aiming to develop more effective treatments.https://www.mdpi.com/1718-7729/32/3/171brain metastasesnon-small-cell lung cancerimmune systemtumor microenvironmentimmune checkpoint inhibitors
spellingShingle Meng Wang
Jihua Yang
Shuai Wang
Harjot Gill
Haiying Cheng
Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
Current Oncology
brain metastases
non-small-cell lung cancer
immune system
tumor microenvironment
immune checkpoint inhibitors
title Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
title_full Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
title_fullStr Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
title_full_unstemmed Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
title_short Immunotherapy and the Tumor Microenvironment in Brain Metastases from Non-Small Cell Lung Cancer: Challenges and Future Directions
title_sort immunotherapy and the tumor microenvironment in brain metastases from non small cell lung cancer challenges and future directions
topic brain metastases
non-small-cell lung cancer
immune system
tumor microenvironment
immune checkpoint inhibitors
url https://www.mdpi.com/1718-7729/32/3/171
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AT shuaiwang immunotherapyandthetumormicroenvironmentinbrainmetastasesfromnonsmallcelllungcancerchallengesandfuturedirections
AT harjotgill immunotherapyandthetumormicroenvironmentinbrainmetastasesfromnonsmallcelllungcancerchallengesandfuturedirections
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