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Parakh S, Park JJ, Mendis S, Rai R, Xu W, Lo S, Drummond M, Rowe C, Wong A, McArthur G, Haydon A, Andrews MC, Cebon J, Guminski A, Kefford RF, Long GV, Menzies AM, Klein O, Carlino MS. Efficacy of anti-PD-1 therapy in patients with melanoma brain metastases. Br J Cancer 2017; 116:1558-1563. [PMID: 28524161 PMCID: PMC5518864 DOI: 10.1038/bjc.2017.142] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/09/2023] Open
Abstract
Background: There is limited data on the efficacy of anti-programmed death 1 (PD-1) antibodies in patients (pts) with melanoma brain metastasis (BM), particularly those which are symptomatic. Method: We retrospectively assessed pts with melanoma BM treated with PD-1 antibodies, nivolumab and pembrolizumab. Clinicopathologic and treatment parameters were collected and outcomes determined for intracranial (IC) response rate (RR) using a modified RECIST criteria, with up to five IC target lesions used to determine IC response, disease control rate (DCR) and progression-free survival (PFS). Results: A total of 66 pts were identified with a median follow up of 7.0 months (range 0.8–24.5 months). A total of 68% were male and 45% BRAF V600 mutation positive. At PD-1 antibody commencement, 50% had an elevated LDH; 64% had local therapy to BM prior to commencing anti-PD1, of which 5% had surgical resection, 14% stereotactic radiosurgery (SRS), 18% whole-brain radiotherapy (WBRT), 27% had surgery and radiotherapy. Twenty-one per cent started anti-PD-1 as first line systemic therapy. No pt had prior anti-PD-1 treatment. The IC overall RR was 21 and DCR 56%. Responses occurred in 21% of pts with symptomatic BM. The median OS was 9.9 months (95% CI 6.93–17.74). Pts with symptomatic BM had shorter PFS than those without symptoms (2.7 vs 7.4 months, P=0.035) and numerically shorter OS (5.7 vs 13.0 months, P=0.068). Pts requiring corticosteroids also had a numerically shorter PFS (3.2 vs 7.4 months, P=0.081) and OS (4.8 vs 13.1 months, P=0.039). Conclusions: IC responses to anti-PD-1 antibodies occur in pts with BM, including those with symptomatic BM requiring corticosteroids. Prospective trials evaluating anti-PD-1 therapy in pts with BM are underway.
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Affiliation(s)
- Sagun Parakh
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia.,La Trobe University School of Cancer Medicine, Melbourne, Victoria 3086, Australia
| | - John J Park
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Shehara Mendis
- Medical Oncology Unit, Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Rajat Rai
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Wen Xu
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Serigne Lo
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Martin Drummond
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Catherine Rowe
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Annie Wong
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Grant McArthur
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Andrew Haydon
- Medical Oncology Unit, Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Miles C Andrews
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Jonathan Cebon
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Alex Guminski
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Richard F Kefford
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Department of Clinical Medicine, Macquarie University, New South Wales 2109, Australia
| | - Georgina V Long
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Alexander M Menzies
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Oliver Klein
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
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Berghoff AS, Venur VA, Preusser M, Ahluwalia MS. Immune Checkpoint Inhibitors in Brain Metastases: From Biology to Treatment. Am Soc Clin Oncol Educ Book 2016; 35:e116-22. [PMID: 27249713 DOI: 10.1200/edbk_100005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer immunotherapy has been a subject of intense research over the last several years, leading to new approaches for modulation of the immune system to treat malignancies. Immune checkpoint inhibitors (anti-CLTA-4 antibodies and anti-PD-1/PD-L1 antibodies) potentiate the host's own antitumor immune response. These immune checkpoint inhibitors have shown impressive clinical efficacy in advanced melanoma, metastatic kidney cancer, and metastatic non-small cell lung cancer (NSCLC)-all malignancies that frequently cause brain metastases. The immune response in the brain is highly regulated, challenging the treatment of brain metastases with immune-modulatory therapies. The immune microenvironment in brain metastases is active with a high density of tumor-infiltrating lymphocytes in certain patients and, therefore, may serve as a potential treatment target. However, clinical data of the efficacy of immune checkpoint inhibitors in brain metastases compared with extracranial metastases are limited, as most clinical trials with these new agents excluded patients with active brain metastases. In this article, we review the current scientific evidence of brain metastases biology with specific emphasis on inflammatory tumor microenvironment and the evolving state of clinical application of immune checkpoint inhibitors for patients with brain metastases.
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Affiliation(s)
- Anna S Berghoff
- From the German Cancer Research Center, University of Heidelberg, Heidelberg, Germany; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center Vienna CNS Unit, Vienna, Austria; Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Vyshak A Venur
- From the German Cancer Research Center, University of Heidelberg, Heidelberg, Germany; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center Vienna CNS Unit, Vienna, Austria; Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Matthias Preusser
- From the German Cancer Research Center, University of Heidelberg, Heidelberg, Germany; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center Vienna CNS Unit, Vienna, Austria; Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Manmeet S Ahluwalia
- From the German Cancer Research Center, University of Heidelberg, Heidelberg, Germany; Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center Vienna CNS Unit, Vienna, Austria; Division of Hematology and Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA; Burkhardt Brain Tumor and Neuro-Oncology Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH; Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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