Jiang Betty S, Beasley Georgia M, Speicher Paul J, Mosca Paul J, Morse Michael A, Hanks Brent, Salama April, Tyler Douglas S
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2014 Aug;21(8):2525-31. doi: 10.1245/s10434-014-3671-0. Epub 2014 Apr 4.
Following regional chemotherapy (RC) for melanoma, approximately 75 % of patients will progress. The role of immunotherapy after RC has not been well established.
A prospective, single-institution database of 243 patients with in-transit melanoma (1995-2013) was queried for patients who had progression of disease after RC with melphalan and subsequently received systemic immunotherapy. Fifteen patients received IL-2 only, 12 received ipilimumab only, and 6 received IL-2 followed by ipilimumab. Fisher's exact test was used to determine if there was a difference in number of complete responders after immunotherapy.
With IL-2 alone, all patients progressed. After ipilimumab alone, three patients had a complete response and nine had progressive disease. Six additional patients received IL-2 first then ipilimumab. All six progressed on IL-2 but three went on to have a complete response to ipilimumab while three progressed. The use of ipilimumab at any time in patients who progressed after RC was associated with higher rate of complete response compared to use of IL-2 alone (33 vs. 0 %; p = 0.021).
Patients with progression after regional therapy for melanoma may benefit from immunologic therapy. In this group of patients, immune checkpoint blockade with ipilimumab has a higher complete response rate than T cell stimulation with IL-2, with no complete responders in the IL-2 only group. Furthermore, the complete response rate for ipilimumab in our cohort is higher than reported response rates in the literature for ipilimumab alone, suggesting that the effects of immunotherapy may be bolstered by previous regional treatment.
黑色素瘤患者接受区域化疗（RC）后，约75%的患者会出现病情进展。RC后免疫治疗的作用尚未明确。
查询了一个前瞻性、单机构的数据库，该数据库纳入了1995年至2013年期间243例患有移行转移黑色素瘤的患者，筛选出接受美法仑RC治疗后病情进展且随后接受全身免疫治疗的患者。15例患者仅接受白细胞介素-2（IL-2）治疗，12例仅接受伊匹单抗治疗，6例先接受IL-2治疗，随后接受伊匹单抗治疗。采用Fisher精确检验来确定免疫治疗后完全缓解者的数量是否存在差异。
单独使用IL-2治疗时，所有患者病情均进展。单独使用伊匹单抗治疗后，3例患者完全缓解，9例病情进展。另外6例患者先接受IL-2治疗，然后接受伊匹单抗治疗。这6例患者在接受IL-2治疗时均病情进展，但其中3例对伊匹单抗治疗完全缓解，3例病情进展。与单独使用IL-2相比，RC后病情进展的患者在任何时间使用伊匹单抗，其完全缓解率更高（33%对0%；p = 0.021）。
黑色素瘤区域治疗后病情进展的患者可能从免疫治疗中获益。在这组患者中，伊匹单抗免疫检查点阻断的完全缓解率高于IL-2刺激T细胞，仅接受IL-2治疗的组中无完全缓解者。此外，我们队列中伊匹单抗的完全缓解率高于文献报道的单独使用伊匹单抗的缓解率，这表明先前的区域治疗可能会增强免疫治疗的效果。
