Ipilimumab [Neurosurgery Wiki]

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====== Ipilimumab ======

The approval of ipilimumab-the first in class [[immune checkpoint inhibitor]]-in [[2011]] serves as a landmark period of time in the resurgence of [[immunotherapy]] for cancer.

Monoclonal antibody against cytotoxic T lymphocyte antigen-4 (CTLA-4) antigen. More effective in patients who do not require corticosteroids.

===== Ipilimumab for melanoma brain metastases =====

[[Ipilimumab for melanoma brain metastases]].


===== Case reports =====

A 57-year-old man presented with visual [[deterioration]] and [[bitemporal hemianopsia]]. [[MRI]] of the [[brain]] demonstrated a [[sella]]r [[mass]] suspected to be [[pituitary macroadenoma]] with a displacement of the [[stalk]] and [[optic nerve]] [[impingement]]. The patient underwent stereotactic [[endoscopic]] [[transsphenoidal]] [[resection]] of the mass. Postoperative MRI demonstrated [[gross total resection]]. [[Pathology]] revealed a sparsely granulated [[corticotroph adenoma]] with [[malignant]] [[transformation]]. [[Immunohistochemistry]] showed a loss of expression of [[MLH1]] and [[PMS2]] in the tumor cells. [[Proton therapy]] was recommended given an elevated [[Ki67]] index and [[p53]] positivity. Before [[radiotherapy]], there was no radiographic evidence of residual tumor. Temozolomide therapy was initiated after surveillance MRI showed recurrence at 16 months postoperatively. However, MRI demonstrated marked progression after 3 cycles. Next-generation sequencing using the MSK-IMPACT platform identified somatic mutations in MLH1 Y548lfs*9 and TP53 R337C. Immunotherapy with [[ipilimumab]]/[[nivolumab]] was initiated, and MRI demonstrated no residual tumor burden 34 months postoperatively.

APA is a tumor with frequent [[recurrence]] and a short median expected length of [[survival]]. Shah et al. demonstrated the utility of [[immunotherapy]] in a single case report of APA, with complete resolution of recurrent APA and improved survival compared with a life expectancy
((Shah S, Manzoor S, Rothman Y, Hagen M, Pater L, Golnik K, Mahammedi A, Lin AL, Bhabhra R, Forbes JA, Sengupta S. Complete Response of a Patient With a Mismatch Repair Deficient Aggressive pituitary neuroendocrine tumor to [[Immune Checkpoint Inhibitor]] Therapy: A Case Report. Neurosurgery. 2022 May 13. doi: 10.1227/neu.0000000000002024. Epub ahead of print. PMID: 35544035.)).