Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition
Abstract Background Immunotherapy, in particular checkpoint blockade, has changed the clinical landscape of metastatic melanoma. Nonetheless, the majority of patients will either be primary refractory or progress over follow up. Management of patients progressing on first-line immunotherapy remains...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2018-04-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40425-018-0338-6 |
| _version_ | 1818507531393171456 |
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| author | Zoë Blake Douglas K. Marks Robyn D. Gartrell Thomas Hart Patti Horton Simon K. Cheng Bret Taback Basil A. Horst Yvonne M. Saenger |
| author_facet | Zoë Blake Douglas K. Marks Robyn D. Gartrell Thomas Hart Patti Horton Simon K. Cheng Bret Taback Basil A. Horst Yvonne M. Saenger |
| author_sort | Zoë Blake |
| collection | DOAJ |
| description | Abstract Background Immunotherapy, in particular checkpoint blockade, has changed the clinical landscape of metastatic melanoma. Nonetheless, the majority of patients will either be primary refractory or progress over follow up. Management of patients progressing on first-line immunotherapy remains challenging. Expanded treatment options with combination immunotherapy has demonstrated efficacy in patients previously unresponsive to single agent or alternative combination therapy. Case presentation We describe the case of a patient with diffusely metastatic melanoma, including brain metastases, who, despite being treated with stereotactic radiosurgery and dual CTLA-4/PD-1 blockade (ipilimumab/nivolumab), developed systemic disease progression and innumerable brain metastases. This patient achieved a complete CNS response and partial systemic response with standard whole brain radiation therapy (WBRT) combined with Talimogene laherparepvec (T-Vec) and pembrolizumab. Conclusion Patients who do not respond to one immunotherapy combination may respond during treatment with an alternate combination, even in the presence of multiple brain metastases. Biomarkers are needed to assist clinicians in evidence based clinical decision making after progression on first line immunotherapy to determine whether response can be achieved with second line immunotherapy. |
| first_indexed | 2024-12-10T22:19:44Z |
| format | Article |
| id | doaj.art-ce9cafdbc306493f8df22ea995ddb16b |
| institution | Directory Open Access Journal |
| issn | 2051-1426 |
| language | English |
| last_indexed | 2024-12-10T22:19:44Z |
| publishDate | 2018-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj.art-ce9cafdbc306493f8df22ea995ddb16b2022-12-22T01:31:21ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262018-04-01611810.1186/s40425-018-0338-6Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibitionZoë Blake0Douglas K. Marks1Robyn D. Gartrell2Thomas Hart3Patti Horton4Simon K. Cheng5Bret Taback6Basil A. Horst7Yvonne M. Saenger8Columbia University Medical Center, Hematology/OncologyNewYork-Prebsyterian/Columbia, Hematology/OncologyColumbia University Medical Center, Hematology/OncologyColumbia University Medical Center, Hematology/OncologyNewYork-Prebsyterian/Columbia, Hematology/OncologyNewYork-Prebsyterian/Columbia, Radiation OncologyNewYork-Prebsyterian/Columbia, SurgeryNewYork-Prebsyterian/Columbia, DermatopathologyNewYork-Prebsyterian/Columbia, Hematology/OncologyAbstract Background Immunotherapy, in particular checkpoint blockade, has changed the clinical landscape of metastatic melanoma. Nonetheless, the majority of patients will either be primary refractory or progress over follow up. Management of patients progressing on first-line immunotherapy remains challenging. Expanded treatment options with combination immunotherapy has demonstrated efficacy in patients previously unresponsive to single agent or alternative combination therapy. Case presentation We describe the case of a patient with diffusely metastatic melanoma, including brain metastases, who, despite being treated with stereotactic radiosurgery and dual CTLA-4/PD-1 blockade (ipilimumab/nivolumab), developed systemic disease progression and innumerable brain metastases. This patient achieved a complete CNS response and partial systemic response with standard whole brain radiation therapy (WBRT) combined with Talimogene laherparepvec (T-Vec) and pembrolizumab. Conclusion Patients who do not respond to one immunotherapy combination may respond during treatment with an alternate combination, even in the presence of multiple brain metastases. Biomarkers are needed to assist clinicians in evidence based clinical decision making after progression on first line immunotherapy to determine whether response can be achieved with second line immunotherapy.http://link.springer.com/article/10.1186/s40425-018-0338-6MelanomaBrain metastasesTalimogene laherparepvecT-VecCheckpoint inhibitorsAnti-PD1 |
| spellingShingle | Zoë Blake Douglas K. Marks Robyn D. Gartrell Thomas Hart Patti Horton Simon K. Cheng Bret Taback Basil A. Horst Yvonne M. Saenger Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition Journal for ImmunoTherapy of Cancer Melanoma Brain metastases Talimogene laherparepvec T-Vec Checkpoint inhibitors Anti-PD1 |
| title | Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition |
| title_full | Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition |
| title_fullStr | Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition |
| title_full_unstemmed | Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition |
| title_short | Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition |
| title_sort | complete intracranial response to talimogene laherparepvec t vec pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint inhibition |
| topic | Melanoma Brain metastases Talimogene laherparepvec T-Vec Checkpoint inhibitors Anti-PD1 |
| url | http://link.springer.com/article/10.1186/s40425-018-0338-6 |
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