Immune checkpoint inhibitors: a milestone in the treatment of melanoma

Abstract

SummaryIt has been known for decades that the immune system is able to detect and destroy tumor cells. In the past, this knowledge -mostly acquired through animal experiments -could not be used to benefit our patients, because immuno-oncological therapeutic approaches in humans had constantly failed over recent decades. With the exception of adjuvant interferon therapy, none of these approaches had found its way into everyday clinical practice, and only very few patients were able to enjoy long-term survival associated with good quality of life. With the advent of novel immunological approaches, the meaning of long-term survival as well as quality of life has been redefined for oncological patients. For the first time, a significant percentage of patients responds to treatment with immune checkpoint inhibitors, showing longterm remission and even cure. It has already become apparent that immunotherapy will in the future be one of the therapeutic mainstays in the treatment of metastatic melanoma as well as many other tumor types. The present review article presents the most important new treatment modalities, their mechanism of action, clinical data regarding treatment response, and adverse events to be expected.

Posterior reversible encephalopathy syndrome in a melanoma patient with dabrafenib and trametinib treatment following immunotherapy

“…One of the previously discussed cases with possible PRES occurred one month after switching a nivolumab treatment directly to dabrafenib plus trametinib without any treatment-free interval [10]. Finally, a late carry-over effect from immunotherapy with ipilimumab plus nivolumab may have been the trigger, as immune-related adverse events may occur even after cessation of immunotherapy [16,17].…”

“…cases of PRES under treatment with VEGF inhibitors such as bevacizumab [15]. Finally, a late carry-over effect from immunotherapy with ipilimumab plus nivolumab may have been the trigger, as immune-related adverse events may occur even after cessation of immunotherapy [16,17]. One of the previously discussed cases with possible PRES occurred one month after switching a nivolumab treatment directly to dabrafenib plus trametinib without any treatment-free interval [10].…”

Simultaneous targeted therapy for metastatic melanoma and hepatitis C

“…Combined therapy of advanced melanoma with BRAF/MEK inhibitors leads to an improvement of overall survival [1][2][3][4][5][6]. In 2014, the combined HCV-NS5A/nucleotide polymerase inhibitor Harvoni ® was approved for the treatment of chronic hepatitis C and demonstrated to be highly effective in previously untreated patients [7].…”

Liquid Biopsy zur Überwachung von Melanompatienten

“…Laut GLOBOCAN traten 2012 weltweit mehr als 232.000 neue Fälle von Hautmelanomen sowie etwa 55.500 dokumentierte melanombedingte Todesfälle auf . Die Behandlungsoptionen umfassen, je nach Tumorstadium, die chirurgische Entfernung des Primärtumors und der Metastasen sowie, bei Fällen ausgedehnter, inoperabler Erkrankungen, Strahlentherapie und/oder systemische Immun‐, zielgerichtete oder Chemotherapie . An diese Verfahren schließen sich regelmäßige Termine zur Nachbeobachtung an, um die Patienten auf Rezidive, Metastasen und Tumormarker im Blut zu kontrollieren .…”