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J Neurooncol. 2016 Sep;129(3):453-460. doi: 10.1007/s11060-016-2190-1. Epub 2016 Jul 4.

Pembrolizumab: first experience with recurrent primary central nervous system (CNS) tumors.

Author information

1
Neuro-Oncology Service, Division of Oncology, Tel Aviv Sourasky Medical Center, 64239, Tel Aviv, Israel. deborahblumenthal@gmail.com.
2
Pediatric Neuro-Oncology Service, Pediatric Hemato-Oncology Department, Chaim Sheba Medical Center, 52621, Tel HaShomer, Israel.
3
Molecular Pathology Service, Department of Pathology, Tel Aviv Sourasky Medical Center, 64239, Tel Aviv, Israel.
4
Leslie and Michael Gaffin Center for Neuro-Oncology, Department of Oncology, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
5
Oncology Institute, Davidoff Center, Rabin Medical Center, 49100, Petah Tikva, Israel.
6
Oncology Institute, Chaim Sheba Medical Center, 52621, Tel HaShomer, Israel.
7
Neuro-Oncology Service, Division of Oncology, Tel Aviv Sourasky Medical Center, 64239, Tel Aviv, Israel.

Abstract

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.

KEYWORDS:

Anti-PD1; Glioblastoma; Immunotherapy; Pembrolizumab; Primary brain tumor

PMID:
27377654
DOI:
10.1007/s11060-016-2190-1
[Indexed for MEDLINE]

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