Response of metastatic mucosal melanoma to immunotherapy: It can get worse before it gets better

Abstract

Immune therapy with checkpoint inhibitors has revolutionized the management of metastatic melanoma. Ipilimumab, nivolumab, and pembrolizumab are all FDA-approved immune checkpoint inhibitors to treat metastatic melanoma. Responses to immune checkpoint inhibitors are usually delayed. An interim progression on restaging computed tomography scans "pseudo-progression" may be observed before response to treatment occur. In this case, we report a significant interim progression of metastatic mucosal melanoma before meaningful responses to immunotherapy occurred. The patient developed significant immune therapy-related colitis and new onset vitiligo. Further restaging computed tomography scans showed sustained tumor response despite stopping the immune therapy.

Increased vessel perfusion predicts the efficacy of immune checkpoint blockade

“…The task of identifying a noninvasive and reliable biomarker of responsiveness to ICB is further complicated by the fact that the response of tumors to immunotherapy differs from their response to chemotherapy and radiotherapy (2,3). Pseudoprogression of lesions during ICB limits the classification of lesion size as a direct correlation of treatment responses (13,14). In this case, the ability to discern real-time physiological changes within the TME is more critical than lesion size in assessing actual antitumor immunity.…”

Immunotherapy in a rare case of primary pelvic retroperitoneal melanoma

“…These studies showed a significant decrease in tumour size. However, there are individual studies that report a period of tumour ‘pseudo-progression’, which means an interim progression of the tumour before achieving a significant response 12 13. Although recent studies using pembrolizumab to treat cutaneous melanoma have shown meaningful responses in clinical trials, reports on successful treatment in extracutaneous melanoma remain scarce.…”

Pembrolizumab-Induced Pancytopenia: A Case Report

“…[1][2][3] With activation of the T cells to fight cancer, there is always a chance that these activated T cells might attack normal tissues, leading to immune-related adverse events such as colitis, hepatitis, pneumonitis, endocrinopathies, skin rash, and rarely encephalitis. [1][2][3] Immune-mediated hematologic toxicity could vary from anemia, thrombocytopenia, and leukopenia to rarely pancytopenia (Table 1). [4][5][6][7][8][9][10][11][12][13][14] We present the first case, to our knowledge, of pembrolizumab-induced pancytopenia to be reported in the literature.…”

“…1 The US Food and Drug Administration approved 3 different immunotherapeutic drugs for the treatment of advanced melanoma: ipilimumab, which is a monoclonal antibody against the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and nivolumab and pembrolizumab, which are monoclonal antibodies against the programmed cell death-1 (PD-1) receptor. 2,3 These monoclonal antibodies are also referred to as "immune checkpoint inhibitors" because they remove the brakes (the checkpoints) from the immune system and activate T cells. [1][2][3] With activation of the T cells to fight cancer, there is always a chance that these activated T cells might attack normal tissues, leading to immune-related adverse events such as colitis, hepatitis, pneumonitis, endocrinopathies, skin rash, and rarely encephalitis.…”

“…2,3 These monoclonal antibodies are also referred to as "immune checkpoint inhibitors" because they remove the brakes (the checkpoints) from the immune system and activate T cells. [1][2][3] With activation of the T cells to fight cancer, there is always a chance that these activated T cells might attack normal tissues, leading to immune-related adverse events such as colitis, hepatitis, pneumonitis, endocrinopathies, skin rash, and rarely encephalitis. [1][2][3] Immune-mediated hematologic toxicity could vary from anemia, thrombocytopenia, and leukopenia to rarely pancytopenia (Table 1).…”