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Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma

Optimal management of locally advanced vaginal mucosal melanoma is poorly understood because of its rarity and unique biology. Patients have a poor prognosis despite aggressive management approaches including pelvic exenteration and adjuvant radiation that carry major morbidities. We report a case o...

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Autores principales: Tarhini, Ahmad A., Hanayneh, Wissam B., Powers, John J., Segura, Carlos M. Moran, Conejo-Garcia, Jose R., Lam, Cesar A., Hakam, Ardeshir, Hoffman, Mitchel S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748561/
https://www.ncbi.nlm.nih.gov/pubmed/36531031
http://dx.doi.org/10.3389/fonc.2022.1044587
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author Tarhini, Ahmad A.
Hanayneh, Wissam B.
Powers, John J.
Segura, Carlos M. Moran
Conejo-Garcia, Jose R.
Lam, Cesar A.
Hakam, Ardeshir
Hoffman, Mitchel S.
author_facet Tarhini, Ahmad A.
Hanayneh, Wissam B.
Powers, John J.
Segura, Carlos M. Moran
Conejo-Garcia, Jose R.
Lam, Cesar A.
Hakam, Ardeshir
Hoffman, Mitchel S.
author_sort Tarhini, Ahmad A.
collection PubMed
description Optimal management of locally advanced vaginal mucosal melanoma is poorly understood because of its rarity and unique biology. Patients have a poor prognosis despite aggressive management approaches including pelvic exenteration and adjuvant radiation that carry major morbidities. We report a case of a patient in early 40’s who experienced complete pathologic response and organ preservation following immunotherapy consisting of 3 cycles of ipilimumab and nivolumab. Treatment was complicated by a high-grade immune mediated hepatitis that eventually resolved with immunosuppressive therapy. Immune monitoring studies utilizing vaginal tumor biopsies showed evidence of enhanced infiltration by CD3+/CD8+ cytotoxic T-cells and increased expression of MHC-I/PD-L1 within the tumor microenvironment following immunotherapy. The patient continues to be without evidence of disease recurrence by radiologic and gynecologic examinations with more than 2 years of follow up from the time of immunotherapy initiation. To our knowledge, this is the only case report in the literature of a patient with locally advanced vaginal mucosal melanoma experiencing a durable complete pathologic response and organ preservation following immune checkpoint blockade as the only treatment approach.
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spelling pubmed-97485612022-12-15 Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma Tarhini, Ahmad A. Hanayneh, Wissam B. Powers, John J. Segura, Carlos M. Moran Conejo-Garcia, Jose R. Lam, Cesar A. Hakam, Ardeshir Hoffman, Mitchel S. Front Oncol Oncology Optimal management of locally advanced vaginal mucosal melanoma is poorly understood because of its rarity and unique biology. Patients have a poor prognosis despite aggressive management approaches including pelvic exenteration and adjuvant radiation that carry major morbidities. We report a case of a patient in early 40’s who experienced complete pathologic response and organ preservation following immunotherapy consisting of 3 cycles of ipilimumab and nivolumab. Treatment was complicated by a high-grade immune mediated hepatitis that eventually resolved with immunosuppressive therapy. Immune monitoring studies utilizing vaginal tumor biopsies showed evidence of enhanced infiltration by CD3+/CD8+ cytotoxic T-cells and increased expression of MHC-I/PD-L1 within the tumor microenvironment following immunotherapy. The patient continues to be without evidence of disease recurrence by radiologic and gynecologic examinations with more than 2 years of follow up from the time of immunotherapy initiation. To our knowledge, this is the only case report in the literature of a patient with locally advanced vaginal mucosal melanoma experiencing a durable complete pathologic response and organ preservation following immune checkpoint blockade as the only treatment approach. Frontiers Media S.A. 2022-11-30 /pmc/articles/PMC9748561/ /pubmed/36531031 http://dx.doi.org/10.3389/fonc.2022.1044587 Text en Copyright © 2022 Tarhini, Hanayneh, Powers, Segura, Conejo-Garcia, Lam, Hakam and Hoffman https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Tarhini, Ahmad A.
Hanayneh, Wissam B.
Powers, John J.
Segura, Carlos M. Moran
Conejo-Garcia, Jose R.
Lam, Cesar A.
Hakam, Ardeshir
Hoffman, Mitchel S.
Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title_full Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title_fullStr Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title_full_unstemmed Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title_short Case Report: Durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
title_sort case report: durable complete pathologic response and organ preservation following ipilimumab and nivolumab for locally advanced primary vaginal mucosal melanoma
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748561/
https://www.ncbi.nlm.nih.gov/pubmed/36531031
http://dx.doi.org/10.3389/fonc.2022.1044587
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