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Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

Ranjan, Surabhi ; Quezado, Martha ; Garren, Nancy ; Boris, Lisa ; Siegel, Christine ; Lopes Abath Neto, Osorio ; Theeler, Brett J ; Park, Deric M ; Nduom, Edjah ; Zaghloul, Kareem A ; Gilbert, Mark R ; Wu, Jing

BMC cancer, 2018-03, Vol.18 (1), p.239-9, Article 239 [Periódico revisado por pares]

England: BioMed Central Ltd

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Título:
Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases
Autor: Ranjan, Surabhi ; Quezado, Martha ; Garren, Nancy ; Boris, Lisa ; Siegel, Christine ; Lopes Abath Neto, Osorio ; Theeler, Brett J ; Park, Deric M ; Nduom, Edjah ; Zaghloul, Kareem A ; Gilbert, Mark R ; Wu, Jing
Assuntos: Analysis ; Antibodies, Monoclonal - pharmacology ; Antibodies, Monoclonal - therapeutic use ; Brain Neoplasms - diagnosis ; Brain Neoplasms - metabolism ; Brain Neoplasms - therapy ; Case Report ; Clinical Decision-Making ; CTLA-4 ; CTLA-4 Antigen - antagonists & inhibitors ; Decision making ; Development and progression ; Diagnosis ; Dosage and administration ; Drug therapy ; Female ; Glioblastoma - diagnosis ; Glioblastoma - metabolism ; Glioblastoma - therapy ; Gliomas ; Humans ; Immune checkpoint inhibitors ; Immunotherapy ; Ipilimumab ; Ipilimumab - pharmacology ; Ipilimumab - therapeutic use ; iRANO ; Male ; Middle Aged ; Nivolumab ; PD-1 ; Programmed Cell Death 1 Receptor - antagonists & inhibitors
É parte de: BMC cancer, 2018-03, Vol.18 (1), p.239-9, Article 239
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: Immune checkpoint inhibitors (ICPIs) are being investigated in clinical trials for patients with glioblastoma. While these therapies hold great promise, management of the patients receiving such treatment can be complicated due to the challenges in recognizing immune-related adverse events caused by checkpoint inhibitor treatment. Brain imaging changes that are the consequence of an inflammatory response may be misinterpreted as disease progression leading to inappropriate premature cessation of treatment. The aim of this study was to, by way of a series of cases, underscore the challenges in determining the nature of contrast-enhancing masses that develop during the treatment of patients with glioblastoma treated with ICPIs. We reviewed the clinical course and management of 4 patients on ICPIs who developed signs of tumor progression on imaging. These findings were examined in the context of Immunotherapy Response Assessment in Neuro-Oncology (iRANO) guidelines. Although all 4 patients had very similar imaging findings, 2 of the 4 patients were later found to have intense inflammatory changes (pseudoprogression) by pathologic examination. A high index of suspicion for pseudoprogression needs to be maintained when a patient with brain tumor on immunotherapy presents with worsening in an area of a pre-existing tumor or a new lesion in brain. Our findings strongly suggest that pathological diagnosis remains the gold standard for distinguishing tumor progression from pseudoprogression in patients receiving immunotherapy. There is a large unmet need to develop reliable non-invasive imaging diagnostic techniques. ClinicalTrials.gov NCT02311920. Registered 8 December 2014.
Editor: England: BioMed Central Ltd
Idioma: Inglês

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Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

Ranjan, Surabhi ; Quezado, Martha ; Garren, Nancy ; Boris, Lisa ; Siegel, Christine ; Lopes Abath Neto, Osorio ; Theeler, Brett J ; Park, Deric M ; Nduom, Edjah ; Zaghloul, Kareem A ; Gilbert, Mark R ; Wu, Jing

England: BioMed Central Ltd

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