Melanoma Brain Metastasis Pseudoprogression after Pembrolizumab Treatment.
Melanoma Brain Metastasis Pseudoprogression after Pembrolizumab Treatment.
复制标题
pembrolizumab治疗后黑色素瘤脑转移伪孕期。
DOI：
10.1158/2326-6066.cir-15-0160
复制
发表时间：
2016-03
影响因子：
10.1
通讯作者：
Kluger HM
中科院分区：
文献类型：
--
作者：
Cohen JV;Alomari AK;Vortmeyer AO;Jilaveanu LB;Goldberg SB;Mahajan A;Chiang VL;Kluger HM
免疫疗法在脑转移瘤治疗中的作用尚不清楚，因为大多数试验排除了脑部活动性病变的患者。随着新的免疫调节剂获得对许多恶性肿瘤的批准，了解它们是否对中枢神经系统(CNS)有独特的影响是很重要的。在这里，我们提出了一例进展性脑转移瘤患者，接受单周期培溴利珠单抗治疗，11天后出现精神状态变化。脑部MRI显示中枢神经系统病变增大，中央强化明显，周围弥漫性水肿。切除的病变的组织学评估显示，孤立的肿瘤细胞簇被反应性星形细胞增多、散布的炎细胞和大量的小胶质细胞包围。鉴于黑色素瘤和其他疾病脑转移患者越来越多地使用免疫检查点抑制剂，识别假性进展和处理免疫抑制是必不可少的。
The role of immunotherapy in treatment of brain metastases is unknown because most trials exclude patients with active brain lesions. As new immunomodulating agents gain approval for many malignancies, it is important to know if they have unique effects in the central nervous system (CNS). Here, we present a case of a patient with progressing brain metastases treated with a single cycle of pembrolizumab, who presented with mental status changes 11 days thereafter. MRI of the brain showed enlargement of CNS lesions with intense central enhancement and diffuse perilesional edema. Histologic evaluation of a resected lesion revealed isolated clusters of tumor cells surrounded by reactive astrocytosis, scattered inflammatory cells, and an abundance of microglial cells. Given the increasing use of immune checkpoint inhibitors in patients with brain metastases from melanoma and other diseases, recognition of pseudoprogression and management with immune suppression are essential.