Lüttmann Nadine, Grätz Victoria, Haase Ozan, Eckey Thomas, Langan Ewan A, Zillikens Detlef, Terheyden Patrick
aDepartment of Dermatology bInstitute for Neuroradiology, University of Lübeck, Lübeck, Germany.
Melanoma Res. 2016 Oct;26(5):528-31. doi: 10.1097/CMR.0000000000000270.
Although ∼40% of patients with metastatic melanoma develop brain metastases, the presence of brain metastases often precludes enrolment in clinical trials for advanced melanoma. However, the development of symptomatic brain metastases markedly increases mortality. The antiprogrammed-death-receptor-1 antibody pembrolizumab achieves extracranial metastases disease response rates of up to 50%. Here, we report the rapid and sustained response of symptomatic multifocal brain metastases in a melanoma ipilimumab-pretreated patient under pembrolizumab, combined with high-dose dexamethasone therapy during the induction phase of therapy. Complete remission has been maintained for over 1 year of follow-up and has correlated with the response rate observed in the extracranial metastases. Radiological disease response was identified during the first follow-up visit in the absence of adjuvant radiotherapy. This report highlights the need for further clinical studies to specifically address the therapeutic potential of antiprogrammed-death-receptor-1 monotherapy in the management of untreated brain metastases in melanoma.
尽管约40%的转移性黑色素瘤患者会发生脑转移，但脑转移的存在常常使患者无法参加晚期黑色素瘤的临床试验。然而，有症状的脑转移的发生会显著增加死亡率。抗程序性死亡受体-1抗体派姆单抗可使颅外转移病灶的疾病缓解率高达50%。在此，我们报告了一名接受过伊匹单抗治疗的黑色素瘤患者，在接受派姆单抗治疗期间，其有症状的多灶性脑转移出现快速且持续的缓解，在治疗诱导期联合了高剂量地塞米松治疗。随访1年多来一直维持完全缓解，且与颅外转移病灶观察到的缓解率相关。在首次随访时未进行辅助放疗的情况下就确定了影像学疾病缓解。本报告强调需要进一步开展临床研究，以专门探讨抗程序性死亡受体-1单药治疗在黑色素瘤未经治疗的脑转移管理中的治疗潜力。
