Melanoma Cancer Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128 Padua, Italy.
Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G Pascale', Via Cappella dei Cangiani, 1, 80131 Naples, Italy.
Br J Cancer. 2014 Apr 2;110(7):1721-6. doi: 10.1038/bjc.2014.126. Epub 2014 Mar 11.
Retreatment with ipilimumab has been shown to re-establish disease control in some patients with disease progression. Here, we report the efficacy and safety of retreatment with ipilimumab 3 mg kg(-1) among patients participating in an expanded access programme in Italy.
Patients who achieved disease control during induction therapy were retreated with ipilimumab upon progression (3 mg kg(-1) every 3 weeks for up to four doses), providing they had not experienced toxicity that precluded further dosing. Tumour assessments were conducted after retreatment, and patients were monitored throughout for adverse events.
Of 855 patients treated with ipilimumab, 51 were retreated upon disease progression. Of these, 28 (55%) regained disease control upon retreatment and 42% were alive 2 years after the first induction dose of ipilimumab; median overall survival was 21 months. Eleven patients (22%) had a treatment-related adverse event of any grade during retreatment. These were generally mild-to-moderate and resolved within a median of 4 days. No new types of toxicity were reported.
For patients who meet predefined criteria, retreatment with ipilimumab is generally well tolerated and can translate into clinical benefit. This strategy should be compared with other therapeutic options in randomised controlled trials.
在一些疾病进展的患者中,再次使用伊匹单抗治疗已显示出重新控制疾病的效果。在此,我们报告了在意大利扩大准入计划中接受伊匹单抗治疗的患者再次使用伊匹单抗的疗效和安全性。
在诱导治疗期间达到疾病控制的患者在疾病进展时(每 3 周 3 mg/kg,最多 4 个剂量)接受伊匹单抗的再次治疗,前提是他们没有出现毒性反应而无法进一步给药。在再次治疗后进行肿瘤评估,并对患者进行全面监测不良反应。
在接受伊匹单抗治疗的 855 名患者中,51 名患者在疾病进展时接受了再次治疗。其中,28 名(55%)在再次治疗后重新获得疾病控制,42%的患者在首次接受伊匹单抗诱导剂量后 2 年仍然存活;中位总生存期为 21 个月。11 名患者(22%)在再次治疗期间出现任何等级的治疗相关不良事件。这些不良事件通常为轻至中度,在中位 4 天内得到解决。未报告新的毒性类型。
对于符合预定标准的患者,再次使用伊匹单抗通常耐受性良好,并可转化为临床获益。这一策略应在随机对照试验中与其他治疗选择进行比较。