Division of Hematology-Oncology, Departments of Neurology and Medicine, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA.
Division of Hematology-Oncology, Departments of Neurology and Medicine, University of Pittsburgh Medical Center, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA.
J Neurooncol. 2018 Sep;139(3):625-631. doi: 10.1007/s11060-018-2907-4. Epub 2018 May 19.
Patients with recurrent high-grade gliomas (HGG) have limited treatment options. HGG utilize the PD-1 pathway to evade immune responses. Checkpoint inhibitors have demonstrated safety and clinical activity in patients with recurrent glioblastoma. We explored the efficacy of nivolumab in recurrent HGG with a primary objective of progression free survival (PFS) and overall survival (OS).
We retrospectively analyzed HGG patients treated with nivolumab in our institution. We included patients with advanced HGG who received nivolumab at their oncologist's decision. Patients received nivolumab 3 mg/kg every 2 weeks until confirmed progression, intolerable toxicity, death, or physician decision. Radiographic assessments were performed every 8 weeks.
Between April 2015 and October 2017, 50 HGG patients received nivolumab. 43 patients received nivolumab with bevacizumab. 44 patients were bevacizumab refractory and 7 patients received nivolumab monotherapy. All had received prior radiation and chemotherapy. 39 adverse events (AEs) were noted [most commonly fatigue (16%) and constipation (10%)]. 4 (8%) patients experienced grade 3-4 AEs. 36 (72%) patients experienced stable disease (SD) at the 2-month assessment. Median duration of SD was 4.3 months (5.1 months in the bevacizumab naïve, 3.8 months in the bevacizumab refractory). Median PFS was 4.3 months (95% CI 3.5-5.3); median OS was 6.5 months (95% CI 6.0-8.8).
Treatment with nivolumab therapy was associated with a manageable safety profile. In a subset of patients, there was disease stabilization in heavily pre-treated recurrent HGG.
复发性高级别神经胶质瘤（HGG）患者的治疗选择有限。HGG 利用 PD-1 通路逃避免疫反应。检查点抑制剂在复发性胶质母细胞瘤患者中显示出安全性和临床活性。我们探讨了纳武单抗在复发性 HGG 中的疗效，主要终点为无进展生存期（PFS）和总生存期（OS）。
我们对我院接受纳武单抗治疗的 HGG 患者进行了回顾性分析。我们纳入了接受纳武单抗治疗的晚期 HGG 患者，这些患者是根据他们的肿瘤医生的决定接受治疗的。患者接受纳武单抗 3 mg/kg，每 2 周一次，直到确认疾病进展、无法耐受毒性、死亡或医生决定停止治疗。每 8 周进行一次影像学评估。
2015 年 4 月至 2017 年 10 月期间，50 例 HGG 患者接受了纳武单抗治疗。43 例患者接受了纳武单抗联合贝伐珠单抗治疗。44 例患者对贝伐珠单抗耐药，7 例患者接受了纳武单抗单药治疗。所有患者均接受过放疗和化疗。共观察到 39 例不良事件（AE）[最常见的是疲劳（16%）和便秘（10%）]。4 例（8%）患者出现 3-4 级 AE。36 例（72%）患者在 2 个月评估时出现疾病稳定（SD）。SD 的中位持续时间为 4.3 个月（贝伐珠单抗初治患者为 5.1 个月，贝伐珠单抗耐药患者为 3.8 个月）。中位 PFS 为 4.3 个月（95%CI 3.5-5.3）；中位 OS 为 6.5 个月（95%CI 6.0-8.8）。
纳武单抗治疗的安全性可管理。在一组患者中，复发性 HGG 患者在经过大量预处理后出现疾病稳定。
