Management of melanoma metastases in the brain

Rutkowski, Piotr; Kiprian, Dorota; Dudzisz-Śledź, Monika; Świtaj, Tomasz; Michalik, R; Spałek, Mateusz; Kozak, Katarzyna; Mandat, Tomasz

doi:10.5603/njo.2019.0018

Cited by 9 publications

(30 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although these results were favorable in terms of disease control and safety large prospective studies are required to confirm the efficacy of nivolumabradiation therapy combination [72]. Based on available data and our own analysis we have also concluded that combination therapy of nivolumab and SRS for patients with intracranial melanoma lesions can be considered as a safe method of treatment [73][74][75]. This combination seems especially effective due to multiple mechanisms of synergy between radiotherapy and immunotherapy including tumor-associated antigen release, MHC I expression elevation, cytokine and chemokine release, CD8+ T-cells APC cells infiltration or MDSC cells reduction within the tumor [76].…”

Section: Safety Of Nivolumab In Challenging Subgroups Of Patientsmentioning

confidence: 59%

An update on the safety of nivolumab for the treatment of advanced melanoma

Czarnecka

Rutkowski

2020

Expert Opinion on Drug Safety

Self Cite

View full text Add to dashboard Cite

Introduction: Due to its unique mechanism of action as an immune checkpoint inhibitor, nivolumab has high antitumor activity, but at the same time this mechanism is responsible for immune-related adverse events that may limit patients' safety and therapy continuation. Areas covered: Long-term safety of nivolumab including 5-year follow-up, safety of nivolumab treatment after ipilimumab therapy, safety of nivolumab in challenging subgroups (elderly, patients with brain metastases, patients with autoimmune disorders), safety of nivolumab in with rare melanoma subtypes (including mucosal melanoma), as well as specificity of AEs reported for nivolumab treatment in melanoma patients in comparison to other cancer types and other immunotherapy molecules, and impact of AEs on response rates and PFS on nivolumab treatment are discussed. Expert opinion: Search for biomarkers that would help us to identify patient populations that may suffer from severe nivolumab toxicity could help in selecting patients that should not be treated with this type of therapy. Novel combinations and immunotherapy drugs including use of NKTR-214 (IL-2 pathway), lymphocyte-activation gene 3 (LAG-3), local injections of talimogene laherparepvec (T-VEC), or systemic use of T-cell receptors agonists such as OX40, CD137, ICOS-1, could provide regimens with limited toxicity and higher activity.

show abstract

Section: Safety Of Nivolumab In Challenging Subgroups Of Patientsmentioning

confidence: 59%

An update on the safety of nivolumab for the treatment of advanced melanoma

Czarnecka

Rutkowski

2020

Expert Opinion on Drug Safety

Self Cite

View full text Add to dashboard Cite

show abstract

“…It seems that these chronic infections could suppress T cell function and theoretically could decrease the effectiveness (particularly in the case of severe HIV/AIDS with a low number of CD4 + T cells) [34]. The principles of procedures for patients with a diagnosis of melanoma with metastases to the CNS have been described in the paper "Management of brain metastases in melanoma" (Piotr Rutkowski, Dorota Kiprian, Monika Dudzisz-Śledź, Tomasz Świtaj, Radosław Michalik, Mateusz Spałek, Katarzyna Kozak, Tomasz Mandat) [35], similarly to the principles of action in the case of combining immunotherapy with radiotherapy "The role of radiotherapy in melanoma" (Mateusz Spałek, Anna M. Czarnecka), which was also presented in "Oncology in Clinical Practice" [36].…”

Section: Discussionmentioning

confidence: 99%

Summary of immunotherapy efficacy ordered in accordance with drug reimbursement program in melanoma patients

Czarnecka

Rutkowski

2020

Oncol Clin Pract

Self Cite

View full text Add to dashboard Cite

Nivolumab and pembrolizumab are monoclonal antibodies of the IgG4 class, which target the cell death receptor (PD-1) found on T cells. The binding of the anti-PD-1 drug to the receptor therefore prevents the inhibition of these T cells and increases the immune response against melanoma cells. Pembrolizumab and nivolumab monotherapy has similar efficacy, including PFS and OS. Nivolumab and pembrolizumab immunotherapy are effective regardless of the BRAF mutation status. Currently, the choice between nivolumab and pembrolizumab is primarily dependent on to the frequency of infusions (every 3 weeks for pembrolizumab vs. every 2 weeks for nivolumab or every 6 weeks vs. every 4 weeks). Based on the available data, it can be concluded that autoimmune disease is not an absolute contraindication to the use of immunotherapy, but close clinical monitoring of these patients and specialist consultations (e.g. rheumatologist, dermatologist) must be provided. Patients with severe autoimmune disease who are treated with biologicals or have a history of life-threatening autoimmune disease complications (e.g. severe Crohn's disease) should not be qualified for immunotherapy, as opposed to patients with minimally symptomatic autoimmune disease (e.g., mild dermal psoriasis).

show abstract

“…Almost a half of them will suffer from multiple lesions [8][9][10]. Large but old autopsy studies on died cancer patients, originating from period when autopsies have been performed routinely, showed a higher incidence that ranged between 9% and 26% [11,12]. However, since the incidence of BM increases with better control of systemic disease and prolonged time from initial cancer diagnosis, the real prevalence of cerebral metastases might be significantly higher.…”

Section: Introductionmentioning

confidence: 99%

Brain metastases the challenge of contemporary oncology

Rams

Świtka²,

Kamińska

et al. 2020

Polish Journal of Public Health

View full text Add to dashboard Cite

Brain metastases (BM) represent the most common tumours of the central nervous system with ranged between 2.8 and 14.3 per 100.000. Despite advances in the diagnosis and treatment of brain metastases, such as surgery, chemotherapy and radiotherapy only 2.4% of patients will survive 5 years. BM causes a wide spectrum of neurological symptoms, such as hemiparesis, impaired coordination or walking, aphasia, and seizures. Despite the effective treatment of the primary tumor, in many cases, it does not protect against brain metastases. The main source of BMs in adults is, in descending order, non-small cell lung cancer, followed by breast cancer and melanoma and then renal cancer. Some malignancies particularly tend to produce “late” or “delayed” cerebral metastasis years or even decades after the anti-cancer treatment has been accomplished. There is still a need to develop more effective treatments for cancer and metastases to the brain.

show abstract

Management of melanoma metastases in the brain

Cited by 9 publications

References 47 publications

An update on the safety of nivolumab for the treatment of advanced melanoma

An update on the safety of nivolumab for the treatment of advanced melanoma

Summary of immunotherapy efficacy ordered in accordance with drug reimbursement program in melanoma patients

Brain metastases the challenge of contemporary oncology

Contact Info

Product

Resources

About