Seminars in oncology
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Seminars in oncology · Jun 2015
ReviewImmune checkpoint blockade in patients with melanoma metastatic to the brain.
Metastatic disease to the brain is a frequent manifestation of melanoma and is associated with a very poor outcome. Systemic therapy with cytotoxic chemotherapy provide only a minimal benefit, while surgery and radiotherapy provide in some patients local control but they less frequently affect the overall outcome of melanoma brain metastases (MBM). ⋯ However, since 2010 the anti-CTLA-4 antibody ipilimumab and the BRAF inhibitors, dabrafenib and vemurafenib, have demonstrated initial signs of efficacy in active brain metastases. This chapter reviews the available data and rationale for ongoing and future trials of immune checkpoint-based combination therapy.
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Cancer immunotherapy has become a popular anticancer approach, with the goal of stimulating immune responses against tumor cells. Recent evidence has demonstrated that the use of monoclonal antibodies targeting the programmed death ligand-1 (PD-L1)/programmed death-1 (PD-1) checkpoint pathway can result in well-tolerated clinical responses in a wide variety of tumor types. This review summarizes the safety, clinical activity and biomarker data for the anti-PD-L1 antibody, MPDL3280A, from a phase Ia multicenter, dose-escalation and -expansion trial. The data to date suggest that MPDL3280A is most effective in patients with pre-existing immunity suppressed by PD-L1 and reinvigorated upon antibody treatment.
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Seminars in oncology · Jun 2015
ReviewImmune checkpoint inhibitors in melanoma provide the cornerstones for curative therapies.
Immunotherapy has been revolutionalized by the concept of breaking tolerance. It represents a major paradigm shift that marks the beginning of a new era. The impact of the first checkpoint inhibitors, ie, anti-CTLA-4 (cytotoxic T lymphocyte antigen-4) and anti-PD-1/ anti-PD-L1 (programmed death-1 receptor and its ligand, PD-L1) is unprecedented. ⋯ Another anti-PD-1 antibody (nivolumab) has been recently approved based on phase III trial results in metastatic melanoma without BRAF mutation. Ipilimumab already has been evaluated in the adjuvant setting (European Organization for Research and Treatment of Cancer [EORTC] 18071) and shown to significantly improve recurrence-free survival in stage III patients at high risk of relapse. An adjuvant trial to evaluate pembrolizumab in this population (EORTC 1325) was started in early 2015.