CTLA-4 blockade with ipilimumab induces significant clinical benefit in a female with melanoma metastases to the CNS.
BACKGROUND
A 63-year-old female presented to her primary physician with numbness and weakness in her left leg, which progressed over several days to involve her entire lower extremities. MRI of the spine and brain revealed multiple metastases. The patient received ipilimumab and after 3 months experienced intermittent confusion and focal seizures.


METHODS
Electroencephalogram and MRI scans of the spine and brain, followed by surgical removal of a left frontal cortical brain metastasis and subsequent histological and pathological analyses.


METHODS
Metastatic melanoma from an unknown primary tumor.


RESULTS
The patient was treated with ipilimumab on a compassionate-use program and dexamethasone, celecoxib, and levetiracetam to treat the symptoms and seizures. Postoperative stereotactic radiosurgery was initiated.
Hodi
F Stephen
FS
Melanoma Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. stephen_hodi@dfci.harvard.edu
Oble
Darryl A
DA
Drappatz
Jan
J
Velazquez
Elsa F
EF
Ramaiya
Nikhil
N
Ramakrishna
Naren
N
Day
Arthur L
AL
Kruse
Andrea
A
Mac Rae
Suzanne
S
Hoos
Axel
A
Mihm
Martin
M
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015703:Antigens, CD / Q000378:metabolism*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D060908:CTLA-4 Antigen; D002490:Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000074324:Ipilimumab; D008545:Melanoma / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D011859:Radiography; D016634:Radiosurgery; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D007166:Immunosuppressive Agents; D000074324:Ipilimumab