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A 3D Organotypic Melanoma Spheroid Skin Model
Published on: May 18, 2018
Rapid remission of symptomatic brain metastases in melanoma by programmed-death-receptor-1 inhibition
Nadine Lüttmann1, Victoria Grätz, Ozan Haase
1aDepartment of Dermatology bInstitute for Neuroradiology, University of Lübeck, Lübeck, Germany.
Abstract:
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.
Insights
Pembrolizumab, an anti-programmed death-receptor-1 antibody, demonstrated rapid and sustained remission in a melanoma patient with symptomatic brain metastases. This suggests potential for immunotherapy in managing brain metastases without radiotherapy.
Area of Science:
- Oncology
- Immunotherapy
- Melanoma Research
Background:
- Metastatic melanoma frequently involves the brain, complicating clinical trial enrollment and increasing mortality.
- Current treatments for melanoma brain metastases are limited, especially in patients pretreated with ipilimumab.
Observation:
- A patient with ipilimumab-pretreated metastatic melanoma and symptomatic multifocal brain metastases received pembrolizumab with high-dose dexamethasone.
- Rapid and sustained radiological disease response was observed during the first follow-up visit.
Findings:
- Complete remission of brain metastases was maintained for over 1 year.
- The response in brain metastases correlated with extracranial disease response.
- Radiological response was achieved without adjuvant radiotherapy.
Implications:
- Pembrolizumab shows therapeutic potential as monotherapy for untreated melanoma brain metastases.
- Further clinical studies are warranted to confirm the efficacy of anti-programmed death-receptor-1 therapy in brain metastases.
- This approach may offer a new treatment avenue for advanced melanoma patients with brain involvement.
