Cohen Justine V, Alomari Ahmed K, Vortmeyer Alexander O, Jilaveanu Lucia B, Goldberg Sarah B, Mahajan Amit, Chiang Veronica L, Kluger Harriet M
Department of Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut.
Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
Cancer Immunol Res. 2016 Mar;4(3):179-82. doi: 10.1158/2326-6066.CIR-15-0160. Epub 2015 Dec 23.
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.
免疫疗法在脑转移瘤治疗中的作用尚不清楚，因为大多数试验都将有活动性脑病灶的患者排除在外。随着新型免疫调节药物在许多恶性肿瘤中获得批准，了解它们在中枢神经系统（CNS）中是否具有独特作用非常重要。在此，我们报告一例接受单周期派姆单抗治疗的进展性脑转移瘤患者，该患者在治疗11天后出现精神状态改变。脑部MRI显示中枢神经系统病灶增大，中央强化明显，病灶周围弥漫性水肿。对切除病灶的组织学评估显示，肿瘤细胞孤立成簇，周围有反应性星形细胞增生、散在的炎性细胞和大量小胶质细胞。鉴于免疫检查点抑制剂在黑色素瘤和其他疾病脑转移患者中的使用日益增加，认识假性进展并进行免疫抑制治疗至关重要。
