Concurrent radiotherapy and ipilimumab immunotherapy for patients with melanoma.
Concurrent radiotherapy and ipilimumab immunotherapy for patients with melanoma.
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DOI：
10.1158/2326-6066.cir-13-0082
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发表时间：
2013-08
影响因子：
10.1
通讯作者：
Wolchok JD
中科院分区：
文献类型：
--
作者：
Barker CA;Postow MA;Khan SA;Beal K;Parhar PK;Yamada Y;Lee NY;Wolchok JD
伊匹单抗和放射治疗（RT）通常用于治疗不可切除和转移性黑色素瘤。临床前研究和病例报告的结果表明这两种治疗之间存在生物相互作用。为了了解相互作用的临床意义，我们进行了一项回顾性研究，回顾了我们机构 2005 年至 2011 年间接受伊匹单抗和放疗治疗黑色素瘤的患者记录。回顾包括治疗、反应、不良事件 (AE) 和总生存 (OS) 的详细信息。 29 名患者在首次服用伊匹单抗和最后一次服用易普利姆玛之间接受了 33 个疗程的非脑部 RT。在接受 10 mg/kg 易普利姆玛治疗的患者中，有 43% 观察到了免疫相关 AE（ir-AE）；在接受 3 mg/kg 易普利姆玛治疗的患者中，有 22% 的患者出现了免疫相关 AE（ir-AE）；与先前单独使用伊匹单抗的研究相比，ir-AE 的频率没有显着差异。接受较高剂量放疗的患者中，与放疗相关的 AE 明显更为常见。 77% 的患者在放疗后报告症状得到缓解。在伊匹单抗诱导和维持期间接受 RT 的患者的中位 OS 分别为 9 个月和 39 个月。在这项回顾性研究中，同时进行伊匹单抗和放疗与高于预期的 AE 发生率无关，也没有消除放疗的姑息效应或伊匹单抗的生存获益。有必要进行进一步的研究来前瞻性地探索这种治疗组合的功效。
Ipilimumab and radiation therapy (RT) are commonly used to treat unresectable and metastatic melanoma. Results from preclinical studies and case reports suggest a biologic interaction between these two treatments. To understand the clinical implications of the interaction, we performed a retrospective study reviewing records of patients treated with ipilimumab and RT for melanoma at our institution between 2005 and 2011. The review included details of treatment, response, adverse events (AEs), and overall survival (OS). Twenty-nine patients underwent 33 courses of non-brain RT between their first and last dose of ipilimumab. Immune-related AEs (ir-AEs) were observed in 43% of patients receiving ipilimumab at 10 mg/kg, and in 22% of patients receiving 3 mg/kg; the frequency of ir-AEs was not significantly different compared to previous studies of ipilimumab alone. RT-related AEs were significantly more common in patients receiving higher doses of radiation. Palliation of symptoms was reported by 77% of patients after RT. Median OS was 9 and 39 months in patients receiving RT during induction and maintenance with ipilimumab, respectively. In this retrospective study, concurrent ipilimumab and RT was not associated with higher than expected rates of AEs, nor did it abrogate palliative effects of RT or survival benefits of ipilimumab. Further studies to prospectively explore the efficacy of this therapeutic combination are warranted.