Complete intracranial response to talimogene laherparepvec (T-Vec), pembrolizumab and whole brain radiotherapy in a patient with melanoma brain metastases refractory to dual checkpoint-inhibition.

摘要: Immunotherapy, in particular checkpoint blockade, has changed the clinical landscape of metastatic melanoma. Nonetheless, majority patients will either be primary refractory or progress over follow up. Management progressing on first-line immunotherapy remains challenging. Expanded treatment options with combination demonstrated efficacy previously unresponsive to single agent alternative therapy. We describe case a patient diffusely melanoma, including brain metastases, who, despite being treated stereotactic radiosurgery and dual CTLA-4/PD-1 blockade (ipilimumab/nivolumab), developed systemic disease progression innumerable metastases. This achieved complete CNS response partial standard whole radiation therapy (WBRT) combined Talimogene laherparepvec (T-Vec) pembrolizumab. Patients who do not respond one may during an alternate combination, even presence multiple Biomarkers are needed assist clinicians evidence based decision making after first line determine whether can second immunotherapy.