Melanoma Brain Metastasis Pseudoprogression after Pembrolizumab Treatment

被引：97

作者：

Cohen, Justine V. ^{[1
]}

Alomari, Ahmed K. ^{[2
]}

Vortmeyer, Alexander O. ^{[2
]}

Jilaveanu, Lucia B. ^{[1
]}

Goldberg, Sarah B. ^{[1
]}

Mahajan, Amit ^{[3
]}

Chiang, Veronica L. ^{[4
]}

Kluger, Harriet M. ^{[1
]}

机构：

[1] Yale Univ, Sch Med, Dept Med, Sect Med Oncol, New Haven, CT 06510 USA

[2] Yale Univ, Sch Med, Dept Pathol, New Haven, CT 06510 USA

[3] Yale Univ, Sch Med, Dept Diagnost Radiol, New Haven, CT 06510 USA

[4] Yale Univ, Sch Med, Dept Neurosurg, New Haven, CT USA

来源：

CANCER IMMUNOLOGY RESEARCH | 2016年 / 4卷 / 03期

关键词：

DISSEMINATED MALIGNANT-MELANOMA; MULTICENTER PHASE-II; OPEN-LABEL; CEREBRAL METASTASES; IPILIMUMAB; TRIAL; RADIOSURGERY; FOTEMUSTINE; DETERMINANTS; TEMOZOLOMIDE;

D O I：

10.1158/2326-6066.CIR-15-0160

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 [肿瘤学];

摘要：

The role of immunotherapy in treatment of brain metastases is unknown because most trials exclude patients with active brain lesions. As new immunomodulating agents gain approval for many malignancies, it is important to know if they have unique effects in the central nervous system (CNS). Here, we present a case of a patient with progressing brain metastases treated with a single cycle of pembrolizumab, who presented with mental status changes 11 days thereafter. MRI of the brain showed enlargement of CNS lesions with intense central enhancement and diffuse perilesional edema. Histologic evaluation of a resected lesion revealed isolated clusters of tumor cells surrounded by reactive astrocytosis, scattered inflammatory cells, and an abundance of microglial cells. Given the increasing use of immune checkpoint inhibitors in patients with brain metastases from melanoma and other diseases, recognition of pseudoprogression and management with immune suppression are essential. (C) 2015 AACR.

引用

页码：179 / 182

页数：4

共 26 条

[1]

Temozolomide for the treatment of brain metastases associated with metastatic melanoma: A phase II study [J].

Agarwala, SS ;

Kirkwood, JM ;

Gore, M ;

Dreno, B ;

Thatcher, N ;

Czarnetski, B ;

Atkins, M ;

Buzaid, A ;

Skarlos, D ;

Rankin, EM .

JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (11) :2101-2107

[2]

Phase II Trial of Temozolomide and Sorafenib in Advanced Melanoma Patients with or without Brain Metastases [J].

Amaravadi, Ravi K. ;

Schuchter, Lynn M. ;

McDermott, David F. ;

Kramer, Amy ;

Giles, Lydia ;

Gramlich, Kristi ;

Carberry, Mary ;

Troxel, Andrea B. ;

Letrero, Richard ;

Nathanson, Katherine L. ;

Atkins, Michael B. ;

O'Dwyer, Peter J. ;

Flaherty, Keith T. .

CLINICAL CANCER RESEARCH, 2009, 15 (24) :7711-7718

[3]

Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma:: A phase III study [J].

Avril, MF ;

Aamdal, S ;

Grob, JJ ;

Hauschild, A ;

Mohr, P ;

Bonerandi, JJ ;

Weichenthal, M ;

Neuber, K ;

Bieber, T ;

Gilde, K ;

Porta, VG ;

Fra, J ;

Bonneterre, J ;

Saïag, P ;

Kamanabrou, D ;

Pehamberger, H ;

Sufliarsky, J ;

Larriba, JLG ;

Scherrer, A ;

Menu, Y .

JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (06) :1118-1125

[4]

Ipilimumab and fotemustine in patients with advanced melanoma (NIBIT-M1): an open-label, single-arm phase 2 trial [J].

Di Giacomo, Anna Maria ;

Ascierto, Paolo A. ;

Pilla, Lorenzo ;

Santinami, Mario ;

Ferrucci, Pier Francesco ;

Giannarelli, Diana ;

Marasco, Antonella ;

Rivoltini, Licia ;

Simeone, Ester ;

Nicoletti, Stefania V. L. ;

Fonsatti, Ester ;

Annesi, Diego ;

Queirolo, Paola ;

Testori, Alessandro ;

Ridolfi, Ruggero ;

Parmiani, Giorgio ;

Maio, Michele .

LANCET ONCOLOGY, 2012, 13 (09) :879-886

[5]

Fluids and barriers of the CNS establish immune privilege by confining immune surveillance to a two-walled castle moat surrounding the CNS castle [J].

Engelhardt B. ;

Coisne C. .

Fluids and Barriers of the CNS, 8 (1)

[6]

Dabrafenib in patients with melanoma, untreated brain metastases, and other solid tumours: a phase 1 dose-escalation trial [J].

Falchook, Gerald S. ;

Long, Georgina V. ;

Kurzrock, Razelle ;

Kim, Kevin B. ;

Arkenau, Tobias H. ;

Brown, Michael P. ;

Hamid, Omid ;

Infante, Jeffrey R. ;

Millward, Michael ;

Pavlick, Anna C. ;

O'Day, Steven J. ;

Blackman, Samuel C. ;

Curtis, C. Martin ;

Lebowitz, Peter ;

Ma, Bo ;

Ouellet, Daniele ;

Kefford, Richard F. .

LANCET, 2012, 379 (9829) :1893-1901

[7]

Determinants of outcome in melanoma patients with cerebral metastases [J].

Fife, KM ;

Colman, MH ;

Stevens, GN ;

Firth, IC ;

Moon, D ;

Shannon, KF ;

Harman, R ;

Petersen-Schaefer, K ;

Zacest, AC ;

Besser, M ;

Milton, GW ;

McCarthy, WH ;

Thompson, JF .

JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (07) :1293-1300

[8]

Melanoma Brain Metastases: Is It Time to Reassess the Bias? [J].

Flanigan, Jaclyn C. ;

Jilaveanu, Lucia B. ;

Faries, Mark ;

Sznol, Mario ;

Ariyan, Stephan ;

Yu, James B. ;

Knisely, Jonathan P. S. ;

Chiang, Veronica L. ;

Kluger, Harriet M. .

CURRENT PROBLEMS IN CANCER, 2011, 35 (04) :200-210

[9]

CTLA-4 blockade with ipilimumab induces significant clinical benefit in a female with melanoma metastases to the CNS [J].

Hodi, F. Stephen ;

Oble, Darryl A. ;

Drappatz, Jan ;

Velazquez, Elsa F. ;

Ramaiya, Nikhil ;

Ramakrishna, Naren ;

Day, Arthur L. ;

Kruse, Andrea ;

Mac Rae, Suzanne ;

Hoos, Axel ;

Mihm, Martin .

NATURE CLINICAL PRACTICE ONCOLOGY, 2008, 5 (09) :557-561

[10]

Improved Survival with Ipilimumab in Patients with Metastatic Melanoma [J].

Hodi, F. Stephen ;

O'Day, Steven J. ;

McDermott, David F. ;

Weber, Robert W. ;

Sosman, Jeffrey A. ;

Haanen, John B. ;

Gonzalez, Rene ;

Robert, Caroline ;

Schadendorf, Dirk ;

Hassel, Jessica C. ;

Akerley, Wallace ;

van den Eertwegh, Alfons J. M. ;

Lutzky, Jose ;

Lorigan, Paul ;

Vaubel, Julia M. ;

Linette, Gerald P. ;

Hogg, David ;

Ottensmeier, Christian H. ;

Lebbe, Celeste ;

Peschel, Christian ;

Quirt, Ian ;

Clark, Joseph I. ;

Wolchok, Jedd D. ;

Weber, Jeffrey S. ;

Tian, Jason ;

Yellin, Michael J. ;

Nichol, Geoffrey M. ;

Hoos, Axel ;

Urba, Walter J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (08) :711-723

← 1 2 3 →