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Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports

BACKGROUND: The assessment of tumor size by RECIST using CT scans and MRIs is considered to be standard of care for staging cancer patients. Despite radiologic evidence of widespread disease, we document for the first time that patients were completely free of viable tumor. CASE PRESENTATION: Two pa...

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Autores principales: Schliep, Stefan, Agaimy, Abbas, Cavallaro, Alexander, Kiesewetter, Franklin, Schuler, Gerold, Heinzerling, Lucie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767974/
https://www.ncbi.nlm.nih.gov/pubmed/29332608
http://dx.doi.org/10.1186/s40425-017-0309-3
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author Schliep, Stefan
Agaimy, Abbas
Cavallaro, Alexander
Kiesewetter, Franklin
Schuler, Gerold
Heinzerling, Lucie
author_facet Schliep, Stefan
Agaimy, Abbas
Cavallaro, Alexander
Kiesewetter, Franklin
Schuler, Gerold
Heinzerling, Lucie
author_sort Schliep, Stefan
collection PubMed
description BACKGROUND: The assessment of tumor size by RECIST using CT scans and MRIs is considered to be standard of care for staging cancer patients. Despite radiologic evidence of widespread disease, we document for the first time that patients were completely free of viable tumor. CASE PRESENTATION: Two patients with metastatic melanoma were treated with immune checkpoint inhibitors (ipilimumab/ nivolumab) and progressive metastases were detected on CT-scans performed shortly before histologic examinations. In both patients histologic assessment revealed a complete response with necrotic and scarred lesions free of tumor. One of the patients had started immunotherapy 20 months before with an initial partial response. CONCLUSIONS: This phenomenon of a concealed complete response can lead to overtreatment or unnecessary change in treatment. Thus, it is essential to raise awareness for it. Correct identification of responders to immune checkpoint inhibitor therapy is crucial to spare patients immune-mediated side effects and unnecessary as well as expensive treatment. Regression of metastases without decline in size, in these cases manifesting as complete responses, are probably more common than expected and identified to date. Until such responses can be readily identified by new imaging techniques, we recommend liberal biopsies for histologic assessment of progressive metastases in patients during and/or after immune checkpoint inhibitor therapy.
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spelling pubmed-57679742018-01-25 Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports Schliep, Stefan Agaimy, Abbas Cavallaro, Alexander Kiesewetter, Franklin Schuler, Gerold Heinzerling, Lucie J Immunother Cancer Case Report BACKGROUND: The assessment of tumor size by RECIST using CT scans and MRIs is considered to be standard of care for staging cancer patients. Despite radiologic evidence of widespread disease, we document for the first time that patients were completely free of viable tumor. CASE PRESENTATION: Two patients with metastatic melanoma were treated with immune checkpoint inhibitors (ipilimumab/ nivolumab) and progressive metastases were detected on CT-scans performed shortly before histologic examinations. In both patients histologic assessment revealed a complete response with necrotic and scarred lesions free of tumor. One of the patients had started immunotherapy 20 months before with an initial partial response. CONCLUSIONS: This phenomenon of a concealed complete response can lead to overtreatment or unnecessary change in treatment. Thus, it is essential to raise awareness for it. Correct identification of responders to immune checkpoint inhibitor therapy is crucial to spare patients immune-mediated side effects and unnecessary as well as expensive treatment. Regression of metastases without decline in size, in these cases manifesting as complete responses, are probably more common than expected and identified to date. Until such responses can be readily identified by new imaging techniques, we recommend liberal biopsies for histologic assessment of progressive metastases in patients during and/or after immune checkpoint inhibitor therapy. BioMed Central 2018-01-15 /pmc/articles/PMC5767974/ /pubmed/29332608 http://dx.doi.org/10.1186/s40425-017-0309-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Schliep, Stefan
Agaimy, Abbas
Cavallaro, Alexander
Kiesewetter, Franklin
Schuler, Gerold
Heinzerling, Lucie
Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title_full Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title_fullStr Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title_full_unstemmed Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title_short Concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
title_sort concealed complete response in melanoma patients under therapy with immune checkpoint inhibitors: two case reports
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767974/
https://www.ncbi.nlm.nih.gov/pubmed/29332608
http://dx.doi.org/10.1186/s40425-017-0309-3
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