Proton Craniospinal Irradiation with Immunotherapy in Two Patients with Leptomeningeal Disease from Melanoma.

Autor: Sener U; Department of Neurology, Mayo Clinic, Rochester, MN, USA.; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Webb M; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Breen WG; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Neth BJ; Department of Neurology, Mayo Clinic, Rochester, MN, USA., Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Routman D; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Brown PD; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Mahajan A; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Frechette K; Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Dudek AZ; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Markovic SN; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Block MS; Department of Oncology, Mayo Clinic, Rochester, MN, USA., McWilliams RR; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Dimou A; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Kottschade LA; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Montane HN; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Kizilbash SH; Department of Oncology, Mayo Clinic, Rochester, MN, USA., Campian JL; Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: Journal of immunotherapy and precision oncology [J Immunother Precis Oncol] 2024 Feb 05; Vol. 7 (1), pp. 1-6. Date of Electronic Publication: 2024 Feb 05 (Print Publication: 2024).
DOI: 10.36401/JIPO-23-20
Abstrakt: Introduction: Proton craniospinal irradiation (pCSI) is a treatment option for leptomeningeal disease (LMD), which permits whole neuroaxis treatment while minimizing toxicity. Despite this, patients inevitably experience progression. Adding systemic therapy to pCSI may improve outcomes.
Methods: In this single-institution retrospective case series, we present the feasibility of treatment with pCSI (30Gy, 10 fractions) and an immune checkpoint inhibitor (ICI) in two sequential patients with LMD from melanoma.
Results: The first patient developed LMD related to BRAF V600E-mutant melanoma after prior ICI and BRAF -targeted therapy. After pCSI with concurrent nivolumab, the addition of relatlimab, and BRAF -targeted therapy, he remained alive 7 months after LMD diagnosis despite central nervous system progression. The second patient developed LMD related to BRAF -wildtype melanoma after up-front ICI. He received pCSI with concurrent ipilimumab and nivolumab, then nivolumab maintenance. Though therapy was held for ICI hepatitis, the patient remained progression-free 5 months after LMD diagnosis.
Conclusion: Adding an ICI to pCSI is feasible for patients with LMD and demonstrates a tolerable toxicity profile. While prospective evaluation is ultimately warranted, pCSI with ICI may confer survival benefits, even after prior ICI.
Competing Interests: Conflicts of Interest: None.
Databáze: MEDLINE
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