{"id":17148,"date":"2010-09-24T17:47:17","date_gmt":"2010-09-24T21:47:17","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=17148"},"modified":"2010-09-24T20:41:33","modified_gmt":"2010-09-25T00:41:33","slug":"ipilimumab-buscado-el-el-cisne-negro","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/17148","title":{"rendered":"Ipilimumab buscado el \u00abEl Cisne Negro\u00bb"},"content":{"rendered":"

Presentado por :
\nWilmer Ramos
\nClaudia V. Ramos Caldato<\/span><\/em><\/strong><\/p>\n

El\u00a0\u00a0Ipilimumab\u00a0\u00a0es un nuevo medicamento biol\u00f3gico desarrollado por\u00a0BMS ,\u00a0este es\u00a0\u00a0un anticuerpo monoclonal que act\u00faa sobre la prote\u00edna 4 asociada a los linfocitos T citot\u00f3xicos (CTLA-4),cuyo rol fundamental consiste en\u00a0\u00a0limitar la capacidad de las c\u00e9lulas T para atacar a las c\u00e9lulas tumorales. En este sentido\u00a0\u00a0Ipilimumabes un potenciador de los linfocitos T, que act\u00faa bloqueando de forma espec\u00edfica la se\u00f1al inhibitoria del ant\u00edgeno 4 asociado a los linfocitos T citot\u00f3xicos (CTLA-4).<\/p>\n

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Estos linfocitos son c\u00e9lulas del sistema inmunol\u00f3gico que neutralizan tanto a las c\u00e9lulas infectadas o alteradas por alg\u00fan agente extra\u00f1o, mediante un ataque directo a \u00e9stas. El ant\u00edgeno 4 es una mol\u00e9cula presente en estos linfocitos T, que juega un papel fundamental en la regulaci\u00f3n de las respuestas naturales del sistema inmune. Si se suprime la se\u00f1al emitida por el ant\u00edgeno CTLA-4,\u00a0\u00a0puede aumentar la respuesta del sistema inmune en la lucha contra las enfermedades, o en este caso el resultado de la transformaci\u00f3n maligna de un tejido.<\/p>\n

El Melanoma una grave variedad de c\u00e1ncer de piel, Se trata de un tipo de\u00a0\u00a0tumor altamente invasivo por su capacidad de generar met\u00e1stasis, este\u00a0generalmentese observa a nivel cut\u00e1neo, pero tambi\u00e9n\u00a0\u00a0resulta frecuente en intestino y en\u00a0\u00a0ojo (melanoma\u00a0uveal). A pesar extensivas investigaciones cient\u00edficas en farmacolog\u00eda, el \u00fanico tratamiento efectivo a\u00a0\u00a0la fecha es la resecci\u00f3n quir\u00fargica del tumor primario antes de que logre un grosor mayor de 1\u00a0mm\u00a0y se disemine por el sistema linf\u00e1tico. Por ser altamente metast\u00e1tico es considerado como \u00a0 la forma m\u00e1s grave de c\u00e1ncer de la piel.<\/p>\n


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El a\u00f1o 2009 en\u00a0Estados Unidos\u00a0se reportaron 68.720 casos nuevos y registrados 8.650 decesos. Anualmente se diagnostican\u00a0\u00a0a nivel mundial alrededor de 160.000 casos nuevos,\u00a0\u00a0resultando frecuente este fen\u00f3meno en individuos de sexo masculino y personas de raza blanca. De acuerdo con el reporte de la Organizaci\u00f3n Mundial de la Salud, Anualmente\u00a0\u00a0ocurren cerca de 48.000-50.000 muertes relacionadas con el melanoma. Se estima que el melanoma maligno produce un 75% de las muertes asociadas al c\u00e1ncer de piel. Por lo general, el riesgo de un individuo de contraer un melanoma depende de dos grupos de factores: intr\u00ednsecos y ambientales. Los factores intr\u00ednsecos incluyen la historia familiar y el genotipo heredado, mientras que el factor ambiental m\u00e1s relevante es la exposici\u00f3n a la luz solar.<\/p>\n

Cuando se hace un diagn\u00f3stico de melanoma tradicionalmente se realiza una evaluaci\u00f3n\u00a0dermatoscopica\u00a0\u00a0y posteriormente una biopsia, de la cual al resultar positivo el diagnostico se procede con\u00a0\u00a0una intervenci\u00f3n que consiste en la\u00a0\u00a0escisi\u00f3n en el \u00e1rea y la remoci\u00f3n de la lesi\u00f3n.\u00a0\u00a0Posteriormente se eliminar\u00eda m\u00e1s piel del \u00e1rea del melanoma, y dicha muestra se observar\u00eda con un microscopio para asegurarse de que no queden c\u00e9lulas cancerosas en la piel. El tama\u00f1o del borde depende del espesor del tumor<\/p>\n

Si el melanoma se encuentra en la cara, los m\u00e1rgenes pudieran ser m\u00e1s peque\u00f1os para evitar desfiguraci\u00f3n. En algunos casos, el cirujano puede que emplee la cirug\u00eda Mohs (aunque no todos los m\u00e9dicos concuerdan con su uso para melanoma). En este procedimiento, la piel (incluyendo el melanoma) se extirpa capa por capa. Cada capa se observa con un microscopio para ver si hay signos de c\u00e1ncer. La operaci\u00f3n contin\u00faa hasta que una capa muestre que no hay signos de c\u00e1ncer. En teor\u00eda, esto permite al cirujano extirpar el c\u00e1ncer mientras se conserva tanto tejido de la piel circundante como sea posible.<\/p>\n

Una vez que el melanoma se ha propagado desde la piel hasta otros \u00f3rganos distantes (tales como los pulmones o el cerebro), el c\u00e1ncer es muy poco probable que sea curable mediante cirug\u00eda. Incluso si s\u00f3lo se detecta una o dos met\u00e1stasis mediante los estudios por im\u00e1genes, tales como la tomograf\u00eda computarizada o las im\u00e1genes por resonancia magn\u00e9tica, es posible que existan otras \u00e1reas de met\u00e1stasis que resultan demasiado peque\u00f1as para poder ser detectadas por medio de estas pruebas.<\/p>\n


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Al encontrarse la enfermedad en una etapa avanzada, la terap\u00e9utica de elecci\u00f3n es radicalmente distinta. Aunque por lo general la quimioterapia no es tan eficaz en el melanoma como en otros tipos de c\u00e1ncer, esta\u00a0\u00a0puede aliviar los s\u00edntomas o prolongar la supervivencia para algunos pacientes. Se pueden usar diferentes f\u00e1rmacos para tratar el melanoma: entre estos esta la\u00a0Dacarbazina\u00a0(llamada tambi\u00e9n DTIC), se puede usar sola o en combinaci\u00f3n con otros medicamentos de quimioterapia como la\u00a0carmustina\u00a0(conocida tambi\u00e9n como BCNU) y el cisplatino.<\/p>\n


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La\u00a0dacarbazina\u00a0lleva us\u00e1ndose mucho tiempo, pero ning\u00fan ensayo\u00a0aleatorizado\u00a0ha demostrado que sea mejor como tratamiento paliativo. La combinaci\u00f3n de estos tres medicamentos, junto con el\u00a0tamoxifeno\u00a0(un medicamento de terapia hormonal) es llamada \u00abr\u00e9gimen de Dartmouth\u00bb.\u00a0Asi\u00a0mismo existen otras alternativas como el cisplatino, la\u00a0vinblastina\u00a0y la DTIC es otra combinaci\u00f3n de quimioterapia para tratar el melanoma. Esto se conoce como \u201cr\u00e9gimen CVD\u201d. Otras opciones igualmente poco eficaces son la\u00a0temozolamida\u00a0cuando esta se combina con el interfer\u00f3n.\u00a0alfa.\u00a0tambien\u00a0esta\u00a0\u00a0reportado el uso de\u00a0paclitaxel\u00a0para tratar el melanoma, ya sea solo o en combinaci\u00f3n con medicamentos como el cisplatino o el\u00a0carboplatino.<\/p>\n


<\/p>\n

En el estudio cl\u00ednico publicado por\u00a0O\u00b4Day\u00a0y colaboradores, cuyos resultados de se\u00a0\u00a0presentaron en el 46\u00ba Congreso Anual de la Sociedad Americana de Oncolog\u00eda Cl\u00ednica (ASCO) y se publicaron este a\u00f1o en\u00a0\u00a0NEJM\u00a0\u00a0(2010). En dicho estudio participaron centros de 13 pa\u00edses de Norteam\u00e9rica, Sudam\u00e9rica,\u00a0\u00a0Europa, Asia y \u00c1frica y se incorpor\u00f3 a los pacientes durante el periodo comprendido entre 2004 y 2008.<\/p>\n


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Los pacientes con melanoma avanzado (etapas 3 a 4) no resecable fueron\u00a0aleatorizados\u00a0a tres grupos de tratamiento en una proporci\u00f3n de 1:3:1:\u00a0ipilimumabm\u00e1s placebo (n = 137),\u00a0ipilimumab\u00a0m\u00e1s la vacuna gp100\u00a0\u00a0(n = 403), y la vacuna gp100 m\u00e1s placebo (n = 136). La vacuna gp100, una vacuna\u00a0pept\u00eddica\u00a0del melanoma experimental tambi\u00e9n concebida para estimular los linfocitos T para que ataquen a las c\u00e9lulas del melanoma, se utiliz\u00f3 como grupo de comparaci\u00f3n despu\u00e9s que estudios previos demostraron que ten\u00eda una actividad antineopl\u00e1sica moderada y que era superior a IL-2.<\/p>\n

Para poder participar en el estudio, los pacientes deb\u00edan tener\u00a0positividad\u00a0para HLA-A0201 pues s\u00f3lo estos tipos de pacientes responden a la vacuna gp100.\u00a0\u00a0ElIpilimumab\u00a0fue administrado\u00a0\u00a0en una dosis de 3\u00a0mg\/kg\u00a0de peso corporal con y sin gp100 cada tres semanas hasta por cuatro ciclos de tratamiento (inducci\u00f3n). El resultado muestran como la supervivencia media global alcanz\u00f3 los 10.1 meses en 137 pacientes cuyo \u00fanico tratamiento activo fue el\u00a0Ipilimumab, 10 meses en 403 pacientes a los que se administr\u00f3\u00a0Ipilimumab\u00a0+ vacuna experimental, y 6.4 meses en 136 pacientes que recibieron vacuna sin\u00a0Ipilimumab, un per\u00edodo de tiempo que entra dentro de la esperanza de vida de 6-9 meses para pacientes con melanoma metast\u00e1tico. La diferencia entre los brazos del estudio tratados con\u00a0Ipilimumab\u00a0y los paciente que recibieron s\u00f3lo la vacuna fue muy alta, con un cociente de riesgos instant\u00e1neos de 0.68, P= .0004. As\u00ed mismo la tasa de supervivencia al a\u00f1o fue casi el doble de alta en los brazos con\u00a0Ipilimumab, 46% frente al 25%, y la tasa a los 2 a\u00f1os, tambi\u00e9n, 24% frente al 14%. A los supervivientes de larga duraci\u00f3n sigue haci\u00e9ndoseles seguimiento 4.5 a\u00f1os despu\u00e9s del tratamiento. Los \u00edndices de control de enfermedad tambi\u00e9n fueron m\u00e1s altos en los 2 brazos con\u00a0Ipilimumab, del 28.5% s\u00f3lo con el\u00a0Ipilimumab\u00a0y del 20.1% con el\u00a0Ipilimumab\u00a0+ vacuna frente al 11% s\u00f3lo con la vacuna. Por su parte, los mejores \u00edndices de respuesta global tambi\u00e9n fueron m\u00e1s altos, del 10.9% y 5.7%, respectivamente, frente al 1.5%. Al igual que en otros ensayos cl\u00ednicos con\u00a0Ipilimumab, los efectos adversos m\u00e1s comunes derivados del tratamiento fueron de tipo inmunol\u00f3gico y basados en su mecanismo de acci\u00f3n. En algunos casos, estos efectos fueron graves y generalmente afectaron a los sistemas gastrointestinal, endocrino, piel e h\u00edgado.<\/p>\n


<\/p>\n

Los resultados de este ensayo con\u00a0Ipilimumab\u00a0son muy esperanzadores y muestran el potencial que tiene la potenciaci\u00f3n del sistema inmunol\u00f3gico para tratar neoplasias como el melanoma metast\u00e1tico. Actualmente el melanoma metast\u00e1tico es uno de los tumores malignos con mayor mortalidad y, adem\u00e1s, carece de opciones terap\u00e9uticas aprobadas y\u00a0estar\u00eda cubriendo una critica\u00a0\u00a0necesidad medica en pacientes con Melanoma metast\u00e1tico avanzado.<\/p>\n


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Dr.Wilmer E. Ramos\u00a0Zerpa.<\/p>\n

Referencias bibliogr\u00e1ficas<\/p>\n


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94. Robinson MR, Chan CC, Yang JC, Rubin BI,\u00a0Gracia\u00a0GJ,\u00a0Sen\u00a0HN, et al.\u00a0Cytotoxic\u00a0T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma: a new cause of\u00a0uveitis. J\u00a0Immunother\u00a02004;27(6):478-9.<\/p>\n

95. Ron I BD, Siegel J,\u00a0Hamid\u00a0O, Minor D,\u00a0Amin\u00a0A, Thompson JA,\u00a0Ridolfi\u00a0R,\u00a0Maraveyas\u00a0A, Weber JS. Efficacy and Safety of Patients with Advanced Melanoma Treated with\u00a0Ipilimumab\u00a0with or without the Addition of Prophylactic\u00a0Budesonide\u00a02008 2008;19(Suppl\u00a08):Abstract 783P.<\/p>\n

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97. Sanderson K, Scotland R, Lee P, Liu D,\u00a0Groshen\u00a0S,\u00a0Snively\u00a0J, et al. Autoimmunity in a phase I trial of a fully human anti-cytotoxic\u00a0T-lymphocyte antigen-4 monoclonal antibody with multiple melanoma peptides and\u00a0Montanide\u00a0ISA 51 for patients with\u00a0resected\u00a0stages III and IV melanoma. J\u00a0Clin\u00a0Oncol\u00a02005;23(4):741-50.<\/p>\n

98.\u00a0Schadendorf\u00a0D WJ,\u00a0Lebb\u00e9\u00a0C,\u00a0Neyns\u00a0B,\u00a0Linette\u00a0G,\u00a0Negrier\u00a0S,\u00a0Lutzky\u00a0J, Thomas L,\u00a0Waterfield\u00a0W,\u00a0Smylie\u00a0M, Guthrie\u00a0Jr\u00a0T, Chin K, Ibrahim R, de\u00a0Pril\u00a0V,\u00a0Grob\u00a0J.-J. . Association Between Lactate\u00a0Dehydrogenase\u00a0Levels and Disease Control and Survival in\u00a0Ipilimumab-Treated Patients with Advanced\u00a0Melanoma\u00a0\u00a0Perspectives\u00a0in Melanoma XII.\u00a0Scheveningen, The Hague, The Netherlands, 2008:Poster\u00a0p-073.<\/p>\n

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100. Small EJ,\u00a0Tchekmedyian\u00a0NS,\u00a0Rini\u00a0BI, Fong L, Lowy I, Allison JP.\u00a0A pilot trial of CTLA-4 blockade with human anti-CTLA-4 in patients with hormone-refractory prostate cancer. Clin Cancer Res 2007;13(6):1810-5.<\/p>\n

101. Small EJ HC, Sartor O, Stein B, Young R, Vestal J, Moseley W,\u00a0Fischkoff\u00a0S,\u00a0Tchekmedyian\u00a0S. Randomized phase II study comparing 4 monthly doses ofipilimumab\u00a0(MDX-010) as a single agent or in combination with a single dose of\u00a0docetaxel\u00a0in patients with hormone-refractory prostate cancer. . J\u00a0Clin\u00a0Oncol2006;24(18S):Abstract 4609.<\/p>\n

102. Smith FO, Goff SL,\u00a0Klapper\u00a0JA, Levy C, Allen T,\u00a0Mavroukakis\u00a0SA, et al. Risk of bowel perforation in patients receiving interleukin-2 after therapy with anti-CTLA 4 monoclonal antibody. J\u00a0Immunother\u00a02007;30(1):130.<\/p>\n

103. Sun J,\u00a0Schiffman\u00a0J,\u00a0Raghunath\u00a0A, Ng Tang D, Chen H, Sharma P. Concurrent decrease in IL-10 with development of immune-related adverse events in a patient treated with anti-CTLA-4 therapy. Cancer\u00a0Immun\u00a02008;8:9.<\/p>\n

104.\u00a0Szabo\u00a0S BK,\u00a0Kotapati\u00a0S,\u00a0Mukherjee\u00a0J,\u00a0Hoos\u00a0A, Levy A. Societal Preferences (Utilities) for Advanced Melanoma health States in the UK and\u00a0Austrailia\u00a0Annual International Meeting of the\u00a0Interntional\u00a0Society for\u00a0Pharmacoecomonics\u00a0and Outcome Research, 2008.<\/p>\n

105.\u00a0Tchekmedyian\u00a0S GJ,\u00a0Korman\u00a0A,\u00a0Keler\u00a0T,\u00a0Deo\u00a0Y, Davis TA MDX-010 (human anti-CTLA4): a phase I trial in malignant melanoma. . J\u00a0Clin\u00a0Oncol\u00a02002;21:Abstract\u00a056.<\/p>\n

106. Thompson J BD, Siegel J, Minor D,\u00a0Amin\u00a0A, Ron I,\u00a0Ridolfi\u00a0R,\u00a0Assi\u00a0H,\u00a0Hamid\u00a0O, Weber JS The efficacy and safety of\u00a0ipilimumab\u00a0monotherapy\u00a0in treatment-naive and previously treated patients with advanced melanoma J\u00a0Clin\u00a0Oncol\u00a02008;26(26):May Suppl.<\/p>\n

107.\u00a0Tomillero\u00a0A, Moral MA.\u00a0Gateways to clinical trials.\u00a0Methods Find Exp\u00a0Clin\u00a0Pharmacol\u00a02008;30(8):643-72.<\/p>\n

108.\u00a0Tomillero\u00a0A, Moral MA.\u00a0Gateways to clinical trials.\u00a0Methods Find Exp\u00a0Clin\u00a0Pharmacol\u00a02008;30(5):383-408.<\/p>\n

109.\u00a0Tomillero\u00a0A, Moral MA.\u00a0Gateways to clinical trials.\u00a0Methods Find Exp\u00a0Clin\u00a0Pharmacol\u00a02008;30(3):231-51.<\/p>\n

110.\u00a0Tsuchihashi\u00a0Z HB, Masters G,\u00a0Lewin\u00a0A,\u00a0Hulmes\u00a0J,\u00a0Korman\u00a0A,\u00a0Payseur\u00a0J, Chen B,\u00a0Caldarelli\u00a0P, Jure-Kunkel M. Biomarker analyses following the anti-CTLA-4 treatment in mouse\u00a0tumor\u00a0models\u00a0\u00a0Proc\u00a0Am Assoc Cancer Res 2007;48:Abstract 231.<\/p>\n

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112.\u00a0Urba\u00a0W HE,\u00a0O\u2019Day\u00a0S, Powderly J, Weber JS. Long-term survival of patients with advanced melanoma who received\u00a0ipilimumab\u00a0administered at 10 mg\/kg every 3 weeks for 4 doses (induction dosing). J\u00a0Clin\u00a0Oncol\u00a02008;26(May 20\u00a0Suppl):Abstract 3018.<\/p>\n

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121. Weber JS BD, Siegel J, Minor D,\u00a0Amin\u00a0A, Thompson J, Ron I,\u00a0Ridolfi\u00a0R,\u00a0Assi\u00a0H,\u00a0O\u2019Day\u00a0S. Efficacy and safety of\u00a0ipilimumab\u00a0with or without prophylacticbudesonide\u00a0in treatment-na\u00efve and previously treated patients with advanced melanoma. J\u00a0Clin\u00a0Oncol\u00a02008;26(May 20\u00a0Suppl):Abstract 9010.<\/p>\n

122. Weber JS BD, Siegel J, Minor D,\u00a0Maraveyas\u00a0A,\u00a0Hamid\u00a0O. Clinical Activity of\u00a0Ipilimumab\u00a0in Patients with Advanced Melanoma and Brain Metastases Ann\u00a0Onc2008;19(Suppl\u00a08):Abstract 786P.<\/p>\n

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125. Weber JS TS, Scotland R,\u00a0Snively\u00a0J, Garcia M,\u00a0Yellin\u00a0M,\u00a0Fischkoff\u00a0S Phase II trial of extended dose anti-CTLA-4 antibody\u00a0ipilimumab\u00a0(formerly MDX-010) with a multi-peptide vaccine for\u00a0resected\u00a0stages IIIC and IV melanoma J\u00a0Clin\u00a0Oncol\u00a02006;24(18S):Abstract 2510.<\/p>\n

126.\u00a0Wolchok\u00a0J IR, De\u00a0Pril\u00a0V,\u00a0Maio\u00a0M,\u00a0Queirolo\u00a0T,\u00a0Harmankaya\u00a0K, Humphrey R,\u00a0Hamid\u00a0O. Antitumor response is observed despite the presence of new lesions in advanced melanoma patients on\u00a0ipilimumab\u00a0treatment J\u00a0Clin\u00a0Oncol\u00a02008;26(May 20\u00a0Suppl):Abstract 3020.<\/p>\n


<\/p>\n

127. Yang JC, Hughes M,\u00a0Kammula\u00a0U, Royal R, Sherry RM,\u00a0Topalian\u00a0SL, et al. Ipilimumab (anti-CTLA4 antibody) causes regression of metastatic renal cell cancer associated with enteritis and\u00a0hypophysitis. J\u00a0Immunother\u00a02007;30(8):825-30.<\/p>\n

128. Yang JC BK,\u00a0Blansfield\u00a0JA, Tran KQ, Rosenberg SA Tumor regression in patients with metastatic renal cancer treated with a monoclonal antibody to CTLA4 (MDX-010) J\u00a0Clin\u00a0Oncol\u00a02005;23(16S):Abstract 2501.<\/p>\n

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130.\u00a0Zhong\u00a0R RR,\u00a0Kipps\u00a0TJ, Ball ED. Maximizing anti-leukemia\u00a0T-cell activity by CTLA-4 blockade in cultures of primary AML cells induced to differentiate to\u00a0dendritic\u00a0cells followed by expansion of in situ\u00a0autologous\u00a0T cells by ligation of CD3 and CD28. . Blood 2003;102(11):Abstract 840.<\/p>\n

131.\u00a0Zhong\u00a0R RR, Ball ED. Enhancement of anti-leukemia T cell activation and expansion by CTLA-4 blockade in cultures of primary acute myeloid leukemia peripheral blood mononuclear cells Exp\u00a0Hematol\u00a02004;32(7 S1):647a.<\/p>\n

132. Zhong RK, Loken M, Lane TA, Ball ED. CTLA-4 blockade by a human\u00a0MAb\u00a0enhances the capacity of AML-derived DC to induce T-cell responses against AML cells in anautologous\u00a0culture system.\u00a0Cytotherapy\u00a02006;8(1):3-12.<\/p>\n

133. Zhou J ZR,\u00a0Kalcheva\u00a0I, Medina B, Ball ED,\u00a0Bashey\u00a0A. Analysis of peripheral blood CD4+\/CD25high\u00a0Treg\u00a0cells and FOCP3 mRNA expression in patients treated with\u00a0ipilimumab\u00a0(monoclonal human anti-CTLA-4, MDX-010) for relapse of malignancy following\u00a0allogeneic\u00a0hematopoietic transplantation Blood 2006;108:Abstract 1735.<\/p>\n

134. Zhou J ZR,\u00a0Corringham\u00a0S, Sapp T,\u00a0Soiffer\u00a0R,\u00a0Mitrovich\u00a0RC, Lowy I,\u00a0Bashey\u00a0A, Ball ED. Flow\u00a0cytometry\u00a0analysis of peripheral blood CD4+\/CD25+\/FOXP3+ T regulator cells from 11 patients treated with\u00a0ipilimumab\u00a0following relapse of malignancy after\u00a0allogeneic\u00a0hematopoietic stem cell transplantation Blood 2007;110(11):Abstract 3240<\/p>\n","protected":false},"excerpt":{"rendered":"

Presentado por : Wilmer Ramos Claudia V. Ramos Caldato El\u00a0\u00a0Ipilimumab\u00a0\u00a0es un nuevo medicamento biol\u00f3gico desarrollado por\u00a0BMS ,\u00a0este es\u00a0\u00a0un anticuerpo monoclonal que act\u00faa sobre la prote\u00edna 4 asociada a los linfocitos T citot\u00f3xicos (CTLA-4),cuyo rol fundamental consiste en\u00a0\u00a0limitar la capacidad de las c\u00e9lulas T para atacar a las c\u00e9lulas tumorales. En este sentido\u00a0\u00a0Ipilimumabes un potenciador de …<\/p>\n","protected":false},"author":54,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[415],"tags":[],"class_list":["post-17148","post","type-post","status-publish","format-standard","","category-melanoma-al-dia"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/17148","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/54"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=17148"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/17148\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=17148"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=17148"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=17148"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}