Murer Carla, Kränzlin-Stieger Pascale, French Lars E, Dummer Reinhard, Goldinger Simone M
Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Melanoma Res. 2017 Aug;27(4):396-398. doi: 10.1097/CMR.0000000000000358.
Treatment of melanoma remains a challenge in advanced disease. Recently, the molecular differentiation in BRAF-mutated, NRAS-mutated and c-kit-mutated melanomas led to new treatment strategies. Different trials show that imatinib or nilotinib lead to meaningful responses in c-kit-mutated melanoma patients. There are little published data on sequential inhibition using these two drugs in melanoma. We describe the sequential use of imatinib after nilotinib in a c-kit-mutated melanoma patient, who progressed on interferon, Allovectin, dacarbazine, nilotinib and ipilimumab, and was finally treated with the c-kit inhibitor imatinib. From July 2011 to September 2011, the patient received ipilimumab (four doses with 3 mg/kg). Clinical assessment after immunotherapy showed disease progression. Therefore, a treatment change to imatinib 800 mg daily was made from February 2012 to May 2013. Under this treatment, the patient showed a partial response as per the RECIST criteria. The present lesions continued responding (computed tomography scans: May 2012-March 2013). Unfortunately, in October 2012, new brain metastases developed. Nevertheless, the use of c-kit inhibitors in c-kit-mutated melanoma patients seems to be a promising treatment option. Furthermore, a delayed response to ipilimumab after 6 months could also have led to or supported the partial response in this case. However, when two biologically similar compounds are administered in a melanoma patient and the tumour mass shows progressive disease upon administration of the first agent, an additional progression with no effect may be expected when the second one is used. This case shows, in contrast, that the use of imatinib after progression upon nilotinib can be beneficial.
黑色素瘤的治疗在晚期疾病中仍然是一项挑战。最近，BRAF突变、NRAS突变和c-kit突变黑色素瘤的分子分化带来了新的治疗策略。不同试验表明，伊马替尼或尼洛替尼在c-kit突变的黑色素瘤患者中可产生有意义的反应。关于在黑色素瘤中序贯使用这两种药物的已发表数据很少。我们描述了在一名c-kit突变的黑色素瘤患者中，尼洛替尼之后序贯使用伊马替尼的情况，该患者在接受干扰素、Allovectin、达卡巴嗪、尼洛替尼和伊匹单抗治疗后病情进展，最终接受了c-kit抑制剂伊马替尼治疗。从2011年7月至2011年9月，该患者接受了伊匹单抗（4剂，3mg/kg）治疗。免疫治疗后的临床评估显示疾病进展。因此，从2012年2月至2013年5月改为每日800mg伊马替尼治疗。在此治疗下，根据RECIST标准患者显示出部分缓解。现有病灶持续缓解（计算机断层扫描：2012年5月至2013年3月）。不幸的是，2012年10月出现了新的脑转移。然而，在c-kit突变的黑色素瘤患者中使用c-kit抑制剂似乎是一种有前景的治疗选择。此外，6个月后对伊匹单抗的延迟反应也可能导致或支持了该病例中的部分缓解。然而，当在一名黑色素瘤患者中给予两种生物学上相似的化合物，且在给予第一种药物时肿瘤肿块显示疾病进展时，使用第二种药物时可能会出现额外的无效果的进展。相比之下，该病例表明在尼洛替尼进展后使用伊马替尼可能是有益的。
