Complete Response After Stereotactic Body Radiation Therapy With Concurrent Immunotherapy for Vaginal Melanoma

Schonewolf, Caitlin; Jaworski, E; Allen, Steven G.; McLean, Karen; Schuchter, Lynn M.; Tanyi, János L.; Taunk, Neil K.

doi:10.1016/j.adro.2021.100839

Cited by 5 publications

(6 citation statements)

References 36 publications

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“…Based on the abovementioned criteria of inclusion/exclusion, a total of 11 studies were considered relevant for the present literature review. Seven studies were case reports and four were reports on the outcomes of retrospective series; no prospective studies were found [7,[14][15][16][17][18][19][20][21][22][23] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Cuccia

D'Alessandro

Blasi³

et al. 2023

JPM

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Among the mucosal melanomas, vaginal melanomas are very rare tumors, accounting for less than 20% of melanomas arising from the female genital tract. They occur most frequently in women in post-menopausal age, but younger patients may also experience this neoplasm, mainly located in the lower third of the vagina or the anterior wall. The optimal management of this tumor remains controversial, with surgery reported as the most frequently adopted approach. However, a clear benefit of surgical treatment in terms of survival has not yet been demonstrated. Conversely, radiotherapy may represent an attractive non-invasive alternative, and there are several favorable reports of the role of radiation therapy, either delivered with photons, brachytherapy, or hadrontherapy. A wide range of techniques and fractionation regimens are reported with substantially good tolerance to the treatment, and acute G3 or higher toxicities are reported only in the case of concurrent immunotherapy. Of note, due to the rarity of the disease, there is a lack of high-level evidence for the optimal therapeutic option. In this scenario, recent studies theorize the possibility of developing combinatorial approaches of radiotherapy with immunotherapy based on cutaneous melanomas reports. In this review, we aim to summarize the evidence available in the literature supporting the role of definitive radiotherapy for vaginal melanomas, with a focus on the combination of RT with immunotherapy, in terms of optimal timing and biological rationale.

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Section: Resultsmentioning

confidence: 99%

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Cuccia

D'Alessandro

Blasi³

et al. 2023

JPM

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“…Malignant vaginal melanomas treated using ICIs are summarized in Table 1 [ 7 – 20 ]. In addition to those described in the current report, 17 cases have been identified, with patients ranging in age from 40 to 85 years.…”

Section: Discussionmentioning

confidence: 99%

“…Yin et al reported a case of recurrent malignant vaginal melanoma in a patient whose sensitivity to toripalimab and lenvatinib was improved using local radiotherapy [ 11 ]. Similarly, Schonewolf et al reported resensitization to pembrolizumab after local radiotherapy in a case of advanced vaginal melanoma [ 7 ]. Here, we report the first case of radiation-induced resensitization to nivolumab, a key drug for treating malignant melanoma.…”

Section: Discussionmentioning

confidence: 99%

“…Tarhini et al reported a complete response to ipilimumab and nivolumab as preoperative therapy for locally advanced vaginal melanoma; however, the patient did not undergo surgery [ 8 ]. Schonewolf et al reported the use of ipilimumab and nivolumab as NAC, but ultimately added radiotherapy after surgery [ 7 ]. Case 2 was the first case in which pure NAC with ICI therapy were administered: combination therapy with ipilimumab and nivolumab caused an inoperable malignant vaginal melanoma with pelvic lymph node metastasis to became operable.…”

Section: Discussionmentioning

confidence: 99%

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Usage of nivolumab and ipilimumab for recurrent or advanced malignant vaginal melanoma: a two-case series

Konishi,

Okamoto,

Tokumitsu

et al. 2024

Med Mol Morphol

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Immune checkpoint inhibitors help treat malignant melanoma, but show limited use in treating malignant vaginal melanoma, an aggressive, rare gynecological malignancy. We identified two patients treated with ipilimumab and nivolumab for vaginal melanoma; both were immunonegative for programmed cell death-ligand 1 and wild-type BRAF. Case 1, a 56-year-old female who underwent radical surgery for stage 1 malignant vaginal melanoma, experienced recurrence 15 months postoperatively. She briefly responded to ipilimumab and nivolumab combination therapy before showing disease progression. Tumor shrinkage occurred with nivolumab and local radiotherapy and, 45 months postoperatively, she survives with the melanoma. Case 2, a 50-year-old female, presented with a 4-cm blackish polypoid vaginal tumor with metastatic pelvic lymph nodes. She received ipilimumab and nivolumab combination therapy for stage III unresectable malignant vaginal melanoma. The vaginal tumor shrank after the third course of treatment, and the lymphadenopathy disappeared. The patient underwent radical surgery and is currently disease-free, using nivolumab for maintenance therapy. Both patients had immune-related adverse events coinciding with periods of high therapeutic efficacy of immune checkpoint inhibitors. Neoadjuvant therapy with immune checkpoint inhibitors and radiotherapy for immune checkpoint inhibitor resensitization may effectively treat advanced or recurrent vaginal melanoma.

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“…Parisi et al (31) reported that a patient with vaginal melanoma achieved CR after HFRT combined with ICIs. Schonewolf et al (32) presented two cases of vaginal melanoma, where both patients achieved CR. The patients were treated at different comprehensive cancer centers using a multimodality approach of immunotherapy and stereotactic body radiation therapy, with or without surgical therapy.…”

Section: Discussionmentioning

confidence: 99%

Near complete remission of a locally advanced giant melanoma of the vulva following hypo‑fractionated radiotherapy and immune checkpoint inhibitors: A case report

et al. 2022

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Melanoma is known to be insensitive to radiotherapy; however, the present study reports the case of a patient with vulvar malignant melanoma in which near complete remission of the target area was observed after implementing immune checkpoint inhibitors (ICIs) and hypo-fractionated radiotherapy (HFRT). The patient was treated with an intensity-modulated radiation therapy technique that delivered a hypo-fractionated dose of 3,000 cGy in six fractions. After 3 days, the patient underwent immunotherapy with two cycles of 240 mg triprizumab every 2 weeks. Tumors that underwent radiotherapy had markedly decreased in size and a near complete remission of the melanoma was observed 4 months after radiotherapy. However, the metastases in the liver and lungs continued to grow, new metastases appeared in the abdominal subcutaneous tissue and enlarged lymph nodes were observed in the pelvic area. The results of the present study indicated that ICIs and HFRT exert a marked local effect, but no abscopal effect.

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Complete Response After Stereotactic Body Radiation Therapy With Concurrent Immunotherapy for Vaginal Melanoma

Cited by 5 publications

References 36 publications

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

The Role of Radiotherapy in the Management of Vaginal Melanoma: A Literature Review with a Focus on the Potential Synergistic Role of Immunotherapy

Usage of nivolumab and ipilimumab for recurrent or advanced malignant vaginal melanoma: a two-case series

Near complete remission of a locally advanced giant melanoma of the vulva following hypo‑fractionated radiotherapy and immune checkpoint inhibitors: A case report

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