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Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment

Combination concepts of radiotherapy and immune checkpoint inhibition are currently of high interest. We examined imaging findings, acute toxicity, and local control in patients with melanoma brain metastases receiving programmed death 1 (PD-1) inhibitors and/or robotic stereotactic radiosurgery (SR...

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Autores principales: Trommer-Nestler, Maike, Marnitz, Simone, Kocher, Martin, Rueß, Daniel, Schlaak, Max, Theurich, Sebastian, von Bergwelt-Baildon, Michael, Morgenthaler, Janis, Jablonska, Karolina, Celik, Eren, Ruge, Maximilian I., Baues, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164579/
https://www.ncbi.nlm.nih.gov/pubmed/30205431
http://dx.doi.org/10.3390/ijms19092653
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author Trommer-Nestler, Maike
Marnitz, Simone
Kocher, Martin
Rueß, Daniel
Schlaak, Max
Theurich, Sebastian
von Bergwelt-Baildon, Michael
Morgenthaler, Janis
Jablonska, Karolina
Celik, Eren
Ruge, Maximilian I.
Baues, Christian
author_facet Trommer-Nestler, Maike
Marnitz, Simone
Kocher, Martin
Rueß, Daniel
Schlaak, Max
Theurich, Sebastian
von Bergwelt-Baildon, Michael
Morgenthaler, Janis
Jablonska, Karolina
Celik, Eren
Ruge, Maximilian I.
Baues, Christian
author_sort Trommer-Nestler, Maike
collection PubMed
description Combination concepts of radiotherapy and immune checkpoint inhibition are currently of high interest. We examined imaging findings, acute toxicity, and local control in patients with melanoma brain metastases receiving programmed death 1 (PD-1) inhibitors and/or robotic stereotactic radiosurgery (SRS). Twenty-six patients treated with SRS alone (n = 13; 20 lesions) or in combination with anti-PD-1 therapy (n = 13; 28 lesions) were analyzed. Lesion size was evaluated three and six months after SRS using a volumetric assessment based on cranial magnetic resonance imaging (cMRI) and acute toxicity after 12 weeks according to the Common Terminology Criteria for Adverse Events (CTCAE). Local control after six months was comparable (86%, SRS + anti-PD-1, and 80%, SRS). All toxicities reported were less than or equal to grade 2. One metastasis (5%) in the SRS group and six (21%) in the SRS + anti-PD-1 group increased after three months, whereas four (14%) of the six regressed during further follow-ups. This was rated as pseudoprogression (PsP). Three patients (23%) in the SRS + anti-PD-1 group showed characteristics of PsP. Treatment with SRS and anti-PD-1 antibodies can be combined safely in melanoma patients with cerebral metastases. Early volumetric progression of lesions under simultaneous treatment may be related to PsP; thus, the evaluation of combined radioimmunotherapy remains challenging and requires experienced teams.
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spelling pubmed-61645792018-10-10 Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment Trommer-Nestler, Maike Marnitz, Simone Kocher, Martin Rueß, Daniel Schlaak, Max Theurich, Sebastian von Bergwelt-Baildon, Michael Morgenthaler, Janis Jablonska, Karolina Celik, Eren Ruge, Maximilian I. Baues, Christian Int J Mol Sci Article Combination concepts of radiotherapy and immune checkpoint inhibition are currently of high interest. We examined imaging findings, acute toxicity, and local control in patients with melanoma brain metastases receiving programmed death 1 (PD-1) inhibitors and/or robotic stereotactic radiosurgery (SRS). Twenty-six patients treated with SRS alone (n = 13; 20 lesions) or in combination with anti-PD-1 therapy (n = 13; 28 lesions) were analyzed. Lesion size was evaluated three and six months after SRS using a volumetric assessment based on cranial magnetic resonance imaging (cMRI) and acute toxicity after 12 weeks according to the Common Terminology Criteria for Adverse Events (CTCAE). Local control after six months was comparable (86%, SRS + anti-PD-1, and 80%, SRS). All toxicities reported were less than or equal to grade 2. One metastasis (5%) in the SRS group and six (21%) in the SRS + anti-PD-1 group increased after three months, whereas four (14%) of the six regressed during further follow-ups. This was rated as pseudoprogression (PsP). Three patients (23%) in the SRS + anti-PD-1 group showed characteristics of PsP. Treatment with SRS and anti-PD-1 antibodies can be combined safely in melanoma patients with cerebral metastases. Early volumetric progression of lesions under simultaneous treatment may be related to PsP; thus, the evaluation of combined radioimmunotherapy remains challenging and requires experienced teams. MDPI 2018-09-07 /pmc/articles/PMC6164579/ /pubmed/30205431 http://dx.doi.org/10.3390/ijms19092653 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Trommer-Nestler, Maike
Marnitz, Simone
Kocher, Martin
Rueß, Daniel
Schlaak, Max
Theurich, Sebastian
von Bergwelt-Baildon, Michael
Morgenthaler, Janis
Jablonska, Karolina
Celik, Eren
Ruge, Maximilian I.
Baues, Christian
Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title_full Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title_fullStr Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title_full_unstemmed Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title_short Robotic Stereotactic Radiosurgery in Melanoma Patients with Brain Metastases under Simultaneous Anti-PD-1 Treatment
title_sort robotic stereotactic radiosurgery in melanoma patients with brain metastases under simultaneous anti-pd-1 treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164579/
https://www.ncbi.nlm.nih.gov/pubmed/30205431
http://dx.doi.org/10.3390/ijms19092653
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