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Effektivitet vid behandling med CTLA-4 inhibitorn ipilimumab hos patienter med avancerat malignt melanom. Är monoterapi eller kombinationsterapi med en PD1-inhibitor att föredra?: En litteraturstudie där ipilimumab jämförs i frånvaro respektive närvaro av en PD1-inhibitor 
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2019 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Malignt melanom är en cancersjukdom som ökar världen över. Sjukdomen är väldigt allvarlig och behandlingen kan vara komplicerad. Det finns idag nya behandlingsmetoder som ökat överlevnaden hos patienter med avancerat malignt melanom. Den monoklonala antikroppen ipilimumab är en sådan. Detta är en CTLA-4 inhibitor som hämmar proteinet CTLA-4 så att T-cellerna inte blir blockerade utan kan vara aktiva och bekämpa cancerceller. Det finns även PD1-inhibitorer som även de aktiverar immunförsvaret. Då både inhibitorer för CTLA-4 och PD-1 aktiverar immunförsvaret men på olika vis, finns förutsättningar för en kombinationsterapi bestående av dessa två. Syftet med detta arbete var att undersöka om behandling av endast ipilimumab är lika effektivt i avseende på överlevnad och tumörtillväxt, som behandling med ipilimumab samt en PD1-inhibitor. Metoden som tillämpades var sökning av artiklar i databasen PubMed. Fem relevanta artiklar valdes ut med hjälp av sökord så som ”ipilimumab” och ”ani-pd1”. Det visade sig att överlevnad och klinisk effekt var bättre hos patienter som behandlades med ipilimumab och en PD1-inhibitor, jämfört med patienter som behandlades med endast ipilimumab. Dock uppstod fler biverkningar hos patienter som blev behandlade med kombinationsterapi. Trots detta, kan det konstateras att en kombinationsterapi bestående av en PD1-inhibitor och en CTLA-4-inhibitor ger bättre respons i form av överlevnad och tumörreducering än monoterapi-behandling med ipilimumab.

Abstract [en]

Malignant melanoma is a cancerous disease that increases worldwide. The disease is very serious, and the treatment can be complicated. There are currently new treatment methods that increase survival in patients with advanced malignant melanoma. The monoclonal antibody ipilimumab is one example. Ipilimumab is a CTLA-4 inhibitor that inhibits the CTLA-4 protein which leads to activity of T-cells. CTLA-4 blocks T-cells from be active and owing to the inhibition of the CTLA-4 protein, the T-cell activation is not blocked. The T-cells can thus be activated and combat cancer cells.  Another example of new therapies are PD1-inhibitors that also activate the immune system. Since both CTLA-4 and PD-1 inhibitors activate the immune system in different ways, there are prerequisites for a combination therapy of these two. The purpose of this thesis was to investigate whether treatment of ipilimumab alone is as effective in survival and tumor growth as combination therapy with ipilimumab and a PD-1 inhibitor in patients with malign melanoma. This is a literature study and the method used was search of articles in the database PubMed. Five relevant articles were selected using the keywords "ipilimumab", "ani-pd1" and “advanced melanoma”. It was found that patients treated with ipilimumab and a PD1-inhibitor had a longer overall survival, compared to patients treated with ipilimumab alone. However, more side effects occurred in patients treated with combination therapy. Patients with combination therapy also had a higher tumor reduction.  Considering that this field of science is comparative new, not so many studies have yet been done. More studies with longer follow-up times should be performed. In conclusion, patients with malign melanoma survive longer and efficiency increases in therapy with both ipilimumab and nivolumab than therapy with only ipilimumab.

Place, publisher, year, edition, pages
2019. , p. 39
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-79933OAI: oai:DiVA.org:lnu-79933DiVA, id: diva2:1282738
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2019-01-28 Created: 2019-01-25 Last updated: 2019-01-28Bibliographically approved

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