TY - JOUR
T1 - Pembrolizumab
T2 - first experience with recurrent primary central nervous system (CNS) tumors
AU - Blumenthal, Deborah T.
AU - Yalon, Michal
AU - Vainer, Gilad W.
AU - Lossos, Alexander
AU - Yust, Shlomit
AU - Tzach, Lior
AU - Cagnano, Emanuela
AU - Limon, Dror
AU - Bokstein, Felix
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Patients with progressive primary brain tumors (PBT) are attracted to promising new treatments, even prior to convincing data. Anti-PD1 immunotherapies have been in the spotlight since publication of groundbreaking results for metastatic melanoma with pembrolizumab (PBL). Our objective was to report on the response and toxicity of PBL in patients with advanced PBT. We retrospectively reviewed the charts of 22 patients (17 adults and 5 children) with recurrent central nervous system tumors treated with PBL. We analyzed prior antineoplastic therapies, steroid usage, and outcomes. Patients received a median of two neoplastic therapies prior to PBL, and a median of three infusions of PBL in adults and four in children. Twelve patients (9 adults and 3 children) started PBL on steroids (median dose in adults 4 mg; range 2–8, and in children 1.5 mg, range 0.5–4) and five patients received steroids later during PBL treatment. Twelve patients (10 adults and 2 children) received concomitant bevacizumab with PBL. Side effects were minimal. All patients showed progressive tumor growth during therapy. Median OS from the start of PBL was 2.6 months in adults and 3.2 months in children. Two GB patients underwent tumor resection following treatment with PBL. Tumor-lymphocytic response in these cases was unremarkable, and PD-L1 immuno-staining was negative. In this series of 22 patients with recurrent primary brain tumors, PBL showed no clinical or histologic efficacy. We do not recommend further use of PBL for recurrent PBT unless convincing prospective clinical trial data are published.
AB - Patients with progressive primary brain tumors (PBT) are attracted to promising new treatments, even prior to convincing data. Anti-PD1 immunotherapies have been in the spotlight since publication of groundbreaking results for metastatic melanoma with pembrolizumab (PBL). Our objective was to report on the response and toxicity of PBL in patients with advanced PBT. We retrospectively reviewed the charts of 22 patients (17 adults and 5 children) with recurrent central nervous system tumors treated with PBL. We analyzed prior antineoplastic therapies, steroid usage, and outcomes. Patients received a median of two neoplastic therapies prior to PBL, and a median of three infusions of PBL in adults and four in children. Twelve patients (9 adults and 3 children) started PBL on steroids (median dose in adults 4 mg; range 2–8, and in children 1.5 mg, range 0.5–4) and five patients received steroids later during PBL treatment. Twelve patients (10 adults and 2 children) received concomitant bevacizumab with PBL. Side effects were minimal. All patients showed progressive tumor growth during therapy. Median OS from the start of PBL was 2.6 months in adults and 3.2 months in children. Two GB patients underwent tumor resection following treatment with PBL. Tumor-lymphocytic response in these cases was unremarkable, and PD-L1 immuno-staining was negative. In this series of 22 patients with recurrent primary brain tumors, PBL showed no clinical or histologic efficacy. We do not recommend further use of PBL for recurrent PBT unless convincing prospective clinical trial data are published.
KW - Anti-PD1
KW - Glioblastoma
KW - Immunotherapy
KW - Pembrolizumab
KW - Primary brain tumor
UR - http://www.scopus.com/inward/record.url?scp=84976878200&partnerID=8YFLogxK
U2 - 10.1007/s11060-016-2190-1
DO - 10.1007/s11060-016-2190-1
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C2 - 27377654
AN - SCOPUS:84976878200
SN - 0167-594X
VL - 129
SP - 453
EP - 460
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 3
ER -