I've ranted and railed about the exclusion of ever so many groups in melanoma treatment...especially in trials - brain mets/CNS disease, previously treated, pre-existing autoimmune disease, other illnesses.... Sooooooo many times. Let's think this through shall we? What happens to untreated melanoma patients?????? Yep. Enough said!
I wrote this post regarding folks with preexisting autoimmune disease earlier this year:
Patients with preexisting immune disease, melanoma, and treatment with Anti-PD-1? Yes, this can be done. Yes, autoimmune flares should be treated with immunosuppressive therapy while on immunotherapy. And YES!!!! These patients can still attain a response!
While these patients certainly require close observation (Then again...don't all folks on immunotherapy???!!!), they can safely and effectively treat their melanoma with immunotherapy!!! Here's one more report:
The
safety of pembrolizumab in metastatic melanoma and rheumatoid
arthritis. Puri and Homsi. Melanoma
Res. 2017 Aug 16.
Immunotherapy
has been in use for the treatment of melanoma since a very long time,
but only recently have the cytotoxic T-lymphocyte antigen-4 (CTLA-4)
antibody ipilimumab and programmed cell death-1 inhibitors such as
nivolimumab and pembrolizumab been shown to induce marked
improvements in survival in patients with metastatic melanoma. An
important concern arises in terms of the safety of the use of these
agents in patients with autoimmune diseases, solid organ transplant
recipients on immunosuppression, patients with a history of previous
hepatitis B or C, and patients with HIV infections as these patients
were excluded from pivotal immunotherapy studies. Here, we report on
the safety and efficacy of pembrolizumab in a melanoma patient with
multiple medical problems including poorly controlled rheumatoid
arthritis and we review the available literature on the use of
immunotherapy and autoimmune diseases. The weight of evidence
suggests that these patients should be offered the opportunity to
benefit from immune check point inhibitors, with drugs targeting
programmed cell death-1 being preferred. More research is required to
study the long-term effects of immunotherapy on patients with
autoimmune diseases.
Hang tough, ratties!!! - c
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