Dzienis Marcin R, Atkinson Victoria G
Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Melanoma Res. 2014 Aug;24(4):349-53. doi: 10.1097/CMR.0000000000000068.
The intracerebral response rate (RR) to vemurafenib in patients with B-RAF mutated melanoma brain metastasis was assessed. Patients with B-RAF-positive metastatic melanoma and asymptomatic brain metastases at initiation of vemurafenib were eligible. Records were analysed retrospectively to calculate the RR, duration of responses, time to central nervous system (CNS) progression and overall survival. Twenty-two patients with CNS metastasis received vemurafenib (male : female=13 : 9; median age 49); 12 had received no previous local therapy to the brain (group A), six had undergone previous surgery and/or radiotherapy with residual disease (group B; n=6) and four patients had received previous local therapy to the brain but with evidence of progression in the CNS before the start of vemurafenib and were included in group A (n=12+4=16). A 50% RR was observed in group A. Duration of responses was between 8 and 32 weeks. Similarly, a 50% RR was observed in group B; however, the contribution of vemurafenib to CNS control in this group was more difficult to assess. The duration of responses in group B was 4-33 weeks. All except two patients progressed in CNS before, or at the time of, systemic progression. The median time to CNS progression for the entire cohort was 23 weeks (range 12-60) in responding patients and 14 weeks (3-22) in those without a response. The median overall survival was 46 weeks for the patients with an objective response and 21 weeks among the nonresponding patients. Vemurafenib resulted in a 50% CNS RR. A prospective assessment of the medication in patients with B-RAF mutated melanoma cerebral metastases is warranted.
评估了携带B-RAF突变的黑色素瘤脑转移患者对维莫非尼的脑内反应率（RR）。符合条件的患者为在开始使用维莫非尼时患有B-RAF阳性转移性黑色素瘤且无症状脑转移的患者。对记录进行回顾性分析以计算RR、反应持续时间、中枢神经系统（CNS）进展时间和总生存期。22例CNS转移患者接受了维莫非尼治疗（男∶女 = 13∶9；中位年龄49岁）；12例之前未接受过脑部局部治疗（A组），6例之前接受过手术和/或放疗但仍有残留病灶（B组；n = 6），4例之前接受过脑部局部治疗但在开始使用维莫非尼之前CNS有进展证据，被纳入A组（n = 12 + 4 = 16）。A组观察到50%的RR。反应持续时间为8至32周。同样，B组也观察到50%的RR；然而，维莫非尼对该组CNS控制的贡献更难评估。B组的反应持续时间为4至33周。除2例患者外，所有患者在全身进展之前或之时CNS均有进展。有反应患者的整个队列的CNS进展中位时间为23周（范围12 - 60周），无反应患者为14周（3 - 22周）。有客观反应的患者中位总生存期为46周，无反应患者为21周。维莫非尼导致50%的CNS RR。有必要对携带B-RAF突变的黑色素瘤脑转移患者的该药物进行前瞻性评估。
