Case Shows Dramatic Antitumor Effects With Immunotherapy in Melanoma

Cytotoxic T-lymphocyte-Associated Protein-4,

Cytotoxic T-lymphocyte-Associated Protein-4,

A letter to the editor in theNew England Journal of Medicinefrom notable researchers at Memorial Sloan Kettering reported a case of complete remission of metastatic melanoma in a patient treated with single doses of ipiliumab and nivolumab.

The complete remission occurred in a patient enrolled in an early phase I trial. Overall results of the 13-patient trial (NCT02186249) showed that more than half (53%) of patients experienced tumor shrinkage of 80% or more.

The best response in the trial, reported in the letter, occurred in a women aged 49 years who had an ulcerated lesion of melanoma skin cancer. The cancer had been removed surgically from an area on her back 4 years prior to the phase I study.

Before treatment, the cancer had metastasized through a large portion of underside of the woman's chest, yet 3 weeks later there was no evidence of disease, including no masses visible on CT scan.

Regarding the response, researchers wrote, “We wish to bring this to the attention of our colleagues…as an example of the potential of immunotherapy to mediate dramatic and rapid antitumor effects.” However, such rapid responses might also carry safety concerns, the researchers noted, “Such an antitumor effect occurring in a transmural metastasis in the small bowel or myocardium, common sites of metastatic melanoma, could have grave consequences. It is ironic that we are now concerned about the possibility of overly vigorous antimelanoma responses.”

The results of this case report, and the small phase I study from which it originated, bode well for the combination of nivolumab and ipilimumab in treatment of advanced cases of metastatic melanoma. With several immunotherapies in development, finding optimal combinations for a variety of patient types and cancer types will likely include a combination of intensive research with results from exceptional cases such as this one.

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Chapman PB, D'Angelo SP, Wolchok JD. Rapid eradication of a bulky melanoma mass with one dose of immunotherapy.N Engl J Med