Immune Checkpoint Inhibitor Therapy as an Eye-Preserving Treatment for Locally Advanced Conjunctival Melanoma

Abstract

The authors present 2 patients with locally advanced conjunctival melanoma for whom definitive surgery would mean an orbital exenteration with its associated inherent total visual loss and major facial disfigurement. Instead both patients were treated with immune checkpoint inhibitor therapy. In 1 patient neoadjuvant pembrolizumab was used for approximately 12 months and the patient experienced near-total clinical resolution of the conjunctival melanoma. Multiple surgical biopsies of very small residual pigmentation showed pigmented macrophages and a complete pathologic response. In the second patient who presented with a locally advanced and metastatic conjunctival melanoma, significant shrinkage of conjunctival mass was observed after treatment with a combination of ipilimumab and nivolumab for 5 months, and this allowed preservation of the eye and ocular function.

Primary Orbital Melanoma: An Investigation of a Rare Malignancy Using the National Cancer Database

“…The reports include multiple accounts of short-term treatment response, but with varied treatment protocols and without long-term follow-up. [32][33][34][35] Only one report describes the use of immunotherapy in POM, however, treatment was stopped due to toxicity and a lack of tumor response. 22 7.8% of the patients in this studied received immunotherapy, however, the NCDB does not supply drug-specific data, which limits the ability to assess the efficacy of specific immunotherapy regimens.…”

Choroidal Nevus Regression in the Setting of Checkpoint Inhibition Immunotherapy

“…3,4 Checkpoint inhibitors have also been reported to be a viable treatment for conjunctival melanoma. 5 The images presented here highlight the progressive depigmentation of a choroidal nevus in a patient receiving immunotherapy. With the increased use of immune checkpoint inhibitors, these observations may be relevant both to the ophthalmologist monitoring choroidal nevi for malignant transformation and the oncologist as an indicator of antimelanoma or antimelanocyte immunity.…”

“…3,4 Checkpoint inhibitors have also been reported to be a viable treatment for conjunctival melanoma. 5…”

Small but Challenging Conjunctival Melanoma: New Insights, Paradigms and Future Perspectives

“…Systemic immunotherapies widely used in cutaneous melanoma for several years could also be beneficial to patients with metastatic CM [ 44 , 112 , 113 , 116 , 117 , 118 ];…”