Vanderbilt University Medical Center.
Mayo Clinic Jacksonville.
Cancer Immunol Res. 2013 Dec;1(6):373-7. doi: 10.1158/2326-6066.CIR-13-0092.
Immune checkpoint inhibitors such as ipilimumab and targeted BRAF inhibitors have dramatically altered the landscape of melanoma therapeutics over the past few years. Agents targeting the programmed cell death-1/ligand (PD-1/PD-L1) axis are now being developed and appear to be highly active clinically with favorable toxicity profiles. We report two patients with BRAF V600E mutant melanoma who were treated with anti-PD-1 agents as first-line therapy without significant toxicity, followed by vemurafenib at disease progression. Both patients developed severe hypersensitivity drug eruptions with multi-organ injury early in their BRAF inhibitor treatment course. One patient subsequently developed acute inflammatory demyelinating polyneuropathy (AIDP) and the other developed anaphylaxis upon low-dose vemurafenib rechallenge. Further investigation of the immune response during combination or sequences of melanoma therapeutics is warranted. Furthermore, clinicians should maintain a high index of suspicion for these toxicities when vemurafenib is administered following an anti-PD-1 agent.
免疫检查点抑制剂,如 ipilimumab 和靶向 BRAF 抑制剂,在过去几年中极大地改变了黑色素瘤治疗的格局。目前正在开发针对程序性细胞死亡蛋白 1/配体(PD-1/PD-L1)轴的药物,并且在临床上具有很高的活性,且毒性特征良好。我们报告了两名接受抗 PD-1 药物作为一线治疗的 BRAF V600E 突变黑色素瘤患者,在疾病进展时,他们未出现明显毒性,随后使用 vemurafenib。在 BRAF 抑制剂治疗过程中,两名患者均出现了严重的过敏药物皮疹,伴有多器官损伤。一名患者随后发展为急性炎症性脱髓鞘性多发性神经病(AIDP),另一名患者在低剂量 vemurafenib 再挑战时发生了过敏反应。有必要进一步研究联合治疗或黑色素瘤治疗方案序列中的免疫反应。此外,当在用抗 PD-1 药物后给予 vemurafenib 时,临床医生应高度怀疑这些毒性。