Rapid complete response of metastatic melanoma in a patient undergoing ipilimumab immunotherapy in the setting of active ulcerative colitis.
Rapid complete response of metastatic melanoma in a patient undergoing ipilimumab immunotherapy in the setting of active ulcerative colitis.
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DOI：
10.1186/s40425-015-0064-2
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发表时间：
2015
影响因子：
10.9
通讯作者：
Hanks BA
中科院分区：
文献类型：
--
作者：
Bostwick AD;Salama AK;Hanks BA
虽然阻断细胞毒性T淋巴细胞抗原-4 (CTLA-4) T细胞调节受体已成为治疗晚期黑色素瘤的常用策略，但在自身免疫性疾病患者群体中使用该药物仍存在许多问题。我们提出了一个病例，涉及治疗患者的IV期黑色素瘤和溃疡性结肠炎（UC）与抗ctla -4抗体免疫治疗。在最初的治疗中，患者发展为III级结肠炎，需要肿瘤坏死因子-α (TNF-α)阻断抗体治疗，然而，在全结肠切除术后再次使用抗ctla -4抗体治疗导致快速完全缓解，并伴有气管支气管炎的发展，这是先前描述的UC的肠外表现。该病例有助于不断发展的自身免疫性疾病患者使用检查点抑制剂的文献，支持未来研究这些药物在自身免疫性疾病患者中使用的临床试验，并表明了解患者自身免疫性病理中涉及的特定分子途径可能为开发更有效的新型组合免疫治疗策略提供见解。
While blockade of the cytotoxic T-lymphocyte antigen-4 (CTLA-4) T cell regulatory receptor has become a commonly utilized strategy in the management of advanced melanoma, many questions remain regarding the use of this agent in patient populations with autoimmune disease. We present a case involving the treatment of a patient with stage IV melanoma and ulcerative colitis (UC) with anti-CTLA-4 antibody immunotherapy. Upon initial treatment, the patient developed grade III colitis requiring tumor necrosis factor-alpha (TNF-α) blocking antibody therapy, however re-treatment with anti-CTLA-4 antibody following a total colectomy resulted in a rapid complete response accompanied by the development of a tracheobronchitis, a previously described extra-intestinal manifestation of UC. This case contributes to the evolving literature on the use of checkpoint inhibitors in patients also suffering from autoimmune disease, supports future clinical trials investigating the use of these agents in patients with autoimmune diseases, and suggests that an understanding of the specific molecular pathways involved in a patient’s autoimmune pathology may provide insight into the development of more effective novel combinatorial immunotherapeutic strategies.