Immune checkpoint inhibition for pediatric patients with recurrent/refractory CNS tumors: a single institution experience.
Adolescent
Adult
Central Nervous System Neoplasms
/ drug therapy
Child
Child, Preschool
Drug Resistance, Neoplasm
/ drug effects
Female
Follow-Up Studies
Humans
Immune Checkpoint Inhibitors
/ therapeutic use
Male
Neoplasm Recurrence, Local
/ drug therapy
Prognosis
Retrospective Studies
Salvage Therapy
Young Adult
CNS tumors
Immunotherapy
PD-1 and CTLA4
Pediatric
Recurrence
Journal
Journal of neuro-oncology
ISSN: 1573-7373
Titre abrégé: J Neurooncol
Pays: United States
ID NLM: 8309335
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
15
05
2020
accepted:
25
06
2020
pubmed:
7
7
2020
medline:
22
6
2021
entrez:
7
7
2020
Statut:
ppublish
Résumé
Immune checkpoint inhibition through PD-1 and CTLA-4 blockade has shown efficacy in some adult malignancies and generated interest in pediatrics, including central nervous system (CNS) tumors. We describe our experience with immune checkpoint inhibition in recurrent/refractory pediatric CNS tumors. We performed a retrospective chart review of pediatric patients with recurrent or refractory CNS tumors treated with ipilimumab, nivolumab and/or pembrolizumab at Dana-Farber/Boston Children's Hospital between 2018 and 2019. Eleven patients were identified. Diagnoses included diffuse intrinsic pontine glioma (DIPG) (n = 2), high-grade glioma (HGG) (n = 5), ependymoma (n = 1), craniopharyngioma (n = 1), high-grade neuroepithelial tumor (n = 1) and non-germinomatous germ cell tumor (NGGCT) (n = 1). Eight patients had recurrent disease, while three had refractory disease. Nine patients received combination therapy (ipilimumab/nivolumab); two patients received either nivolumab or pembrolizumab. Median time from diagnosis-to-treatment was 8 months (range 0.8-156). All patients received prior radiation therapy (RT), with median time from RT-to-immunotherapy was 3.8 years. One patient received concurrent then adjuvant immunotherapy with RT. Median duration of treatment was 6.1 months (range 1-25). Therapy was discontinued in nine patients: seven due to disease progression and two due to toxicity (colitis; transaminitis). Other pertinent toxicities included Type 1 diabetes mellitus, hypothyroidism and skin toxicity. Based on iRANO criteria, best responses included partial response (n = 3), stable disease (n = 7) and progressive disease (n = 1). Durable response was noted in two patients. Immune checkpoint inhibition was relatively well tolerated in a cohort of pediatric patients spanning several CNS tumor diagnoses. Results from prospective clinical trials will be critical to inform clinical decisions.
Identifiants
pubmed: 32627129
doi: 10.1007/s11060-020-03578-6
pii: 10.1007/s11060-020-03578-6
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
113-122Références
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