Immune checkpoint inhibitors for brain metastases

PURPOSE OF REVIEW: Metastasis of cancer to the brain typically portends a poor prognosis and often results in significant morbidity, including from the side effects of treatment. More effective therapies for patients with brain metastases are needed. The current treatment paradigm uses multiple modalities, including surgery, radiation, and in some contexts, systemic chemotherapy and immunotherapy. Immune checkpoint inhibitors are increasingly being used to treat extracranial disease, and their effectiveness in the management of brain metastases needs to be understood. RECENT FINDINGS: The evidence for immune checkpoint inhibitors in the management of brain metastases is largely limited to retrospective analyses of melanoma metastases and ipilimumab. Prospective clinical trials of more active agents are under way, and tentative results suggest activity. Immune checkpoint inhibitors have the potential to improve outcomes in patients with brain metastases. Results of current clinical trials will aid in determining the appropriate sequence or combination of local and systemic therapies.