The introduction of checkpoint inhibitors (ICIs) in renal cell carcinoma (RCC) treatment landscape, resulted in improvements in overall survival (OS) in metastatic patients. Brain metastases (BMs) are a specific metastatic site of interest representing a predictive factor of poor prognosis. Patients with BMs were usually excluded from prospective clinical trials in the past. Despite recent evidence suggest the efficacy and safety of ICIs, the BMs treatment remains a challenge; the immunotherapy responsiveness seems to be multifactorial and dependent on several factors, such as the genetic intratumor heterogeneity and the immunosuppressive role of the brain tumor microenvironment.

This review, starting from the immunological background in RCC BMs, provide an overview of the upcoming evidence from clinical trials, address the issues related to the neuroradiological immunotherapy response evaluation and, with a look to the future, describes how the epigenetic modulation of immune evasion could represent a background for new therapeutic strategies.

检查点抑制剂 (ICI) 在肾细胞癌 (RCC) 治疗领域的引入，提高了转移患者的总生存期 (OS)。脑转移瘤 (BMs) 是一种特定的感兴趣的转移部位，代表了预后不良的预测因素。过去，BMs 患者通常被排除在前瞻性临床试验之外。尽管最近的证据表明 ICI 的有效性和安全性，但 BMs 治疗仍然是一个挑战。免疫治疗反应似乎是多因素的，取决于几个因素，例如肿瘤内的遗传异质性和脑肿瘤微环境的免疫抑制作用。

这篇综述从 RCC BM 的免疫学背景开始，概述了即将到来的临床试验证据，解决了与神经放射免疫治疗反应评估相关的问题，并展望未来，描述了免疫逃避的表观遗传调节可以代表新治疗策略的背景。