Les métastases cérébrales de cancer du rein, un défi clinique

Abstract

Brain metastases from renal cell carcinomas are associated with dismal prognosis and might be present in up to 10 % of metastatic patients. Biologically, the blood brain barrier might be disrupted in brain metastases and thus do not exclusively account for treatment resistance. Brain metastases often acquire additional molecular alterations that might provide aggressive features. They are also associated with high lymphocytic infiltration and expression of immune checkpoints PD-1/PD-L1. In clinical routine, scores based on metastatic volume and patients' performance status might help better predict survival. The cornerstone of brain metastases treatment is stereotactic radiation therapy if patients are eligible, while systemic treatments such as antiangiogenics and immune checkpoint inhibitors only provide limited disease control. Early identification of patients with brain metastases from renal cell carcinomas and promotion of dedicated clinical trials will be important to try and improve current clinical management.

Keywords: Brain metastases; Carcinome à cellules; Immune checkpoint; Immunothérapie; Molecular targeted; Métastases cérébrales; Radiation therapy; Radiothérapie; Renal cell carcinoma; Thérapies; inhibitors; moléculaires ciblées; rénales; therapies.