Abstract
BackgroundHormonal treatment might affect the immune response to tumor antigens induced in cancer patients who are being vaccinated.Case presentationA 33 years-old woman was diagnosed with cutaneous melanoma in May 2009. Her melanoma was located in the intermammary sulcus, had a Breslow thickness of 4 mm, a Clark’s level IV, it was ulcerated and highly melanotic. The bilateral sentinel node biopsy was negative. She entered into a randomized Phase II/III clinical study comparing a vaccine composed of irradiated melanoma cells plus BCG plus GM-CSF versus IFN-alpha 2b and she was assigned to the vaccine arm. During the two years treatment she remained disease-free; the final CAT scan being performed in August 2011. Between November and December 2011, her gynecologist treated her with three cycles of 200 mg progesterone/day for ten days, every two weeks, for ovary dysfunction. In November 2011 the patient returned to the Hospital for clinical and imaging evaluation and no evidence of disease was found. At the next visit in March 2012 an ultrasound revealed multiple, large metastases in the liver. A CAT scan confirmed the presence of liver, adrenal glands and spleen metastases. A needle biopsy of a liver lesion revealed metastatic melanoma of similar characteristics to the original tumor. We suggest that progesterone treatment triggered proliferation of so far dormant micrometastases that were controlled during CSF470 vaccine treatment.ConclusionThe use of progesterone in patients with melanoma that are under immunological treatments should be carefully considered, since progesterone could modify the balance of pro-inflammatory and Th1 functions to a regulatory and anti-inflammatory profile of the immune system that could have an impact in tumor progression.
Highlights
Hormonal treatment might affect the immune response to tumor antigens induced in cancer patients who are being vaccinated.Case presentation: A 33 years-old woman was diagnosed with cutaneous melanoma in May 2009
The use of progesterone in patients with melanoma that are under immunological treatments should be carefully considered, since progesterone could modify the balance of pro-inflammatory and Th1 functions to a regulatory and anti-inflammatory profile of the immune system that could have an impact in tumor progression
After giving written consent she entered into a randomized Phase II/III clinical study comparing the CSF470 vaccine plus Bacillus Calmette-Guerin (BCG) plus Granulocyte-macrophage colony stimulating factor (GM-CSF) versus IFN-alpha, and she was assigned to the vaccine arm
Summary
We believe that this case brings a word of caution to be considered when cancer immunotherapy is combined or concomitantly administered with hormone therapy, evidencing the delicate interactions established between the immune responses elicited by vaccines, the immunemodulating effect of sex hormones and tumor cells. A copy of the consent form is available for review by the Editor of this Journal. Competing interests The authors declare no competing interests. Authors’ contributions JM conceived the study, acquired and interpreted the data and contributed to write the manuscript. MMB contributed to review related literature, prepared the figures and helped to write the manuscript. All authors read and approved the final manuscript. Authors’ information JM and MMB are members of the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). JM is the Principal Investigator of the CASVAC0401 Clinical Study. IJT is a fellow (PhD student) from CONICET
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
