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Growth arrest of a refractory vestibular schwannoma after anti-PD-1 antibody treatment
  1. Frank Kouzel Martinez1,
  2. Christopher Salvatore Graffeo2,
  3. Lucas P Carlstrom2 and
  4. Michael J Link2
  1. 1Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
  2. 2Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Christopher Salvatore Graffeo; Graffeo{at}Gmail.com

Abstract

A 25-year-old man presented with left-sided hearing loss, blurred vision and papilloedema. Imaging revealed a large, left-sided, contrast-enhancing cerebellopontine mass causing obstructive hydrocephalus, consistent with vestibular schwannoma (VS). Following an incomplete resection via retrosigmoid craniotomy at an outside facility, he was referred to our department, and cerebrospinal fluid diversion followed by repeat resection was recommended. A subtotal resection was achieved, and the patient was subsequently treated with adjuvant stereotactic radiosurgery (SRS). Progressive interval growth was observed on serial post-SRS MRI studies; correspondingly, at 31 months after treatment, the patient was initiated on antiprogrammed-death receptor 1 (PD-1) antibody treatment with pembrolizumab. Growth arrest was noted on subsequent serial imaging studies, which have been maintained for a total of 30 months since initiation of a 18-month anti-PD-1 course of therapy. Additional case accumulation and translational study is required to better characterise this therapeutic strategy; however, PD-1/programmed death-ligand 1 inhibition may offer a promising salvage therapy for refractory VS.

  • immunological products and vaccines
  • ear
  • nose and throat/otolaryngology
  • neurootology
  • neurooncology
  • neurology

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Footnotes

  • Twitter @Graffeo

  • Contributors FKM, CSG, LPC and MJL all contributed to the study design, data acquisition and analysis, manuscript drafting and critical revision. All authors have reviewed the submitted manuscript, accept responsibility for its full contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.