Abstract
BackgroundSpontaneous regression of metastatic melanoma and delayed responses more than one year after treatment with ipilimumab are rarely seen.Case presentationHere, we present the case of a patient with in transit metastases from cutaneous melanoma on his right lower extremity who achieved complete regression of all metastatic lesions 13 months after the first of two consecutive palliative resections of dominant masses and more than two years after treatment with ipilimumab.ConclusionThe exact cause of our patient’s sudden onset of tumor regression remains speculative. We hypothesize that the operative trauma followed by the postoperative infections augmented an innate immune response.
Highlights
Spontaneous regression of metastatic melanoma and delayed responses more than one year after treatment with ipilimumab are rarely seen
Immune checkpoint blockade using monoclonal antibodies have been approved by the US Food and Drug Administration (FDA) to treat patients with advanced melanoma
We describe the case of an 84 year old man who presented with multiple in transit melanoma metastases on his right lower extremity that did not respond to ipilimumab, but eventually completely regressed, almost 2 years after the initial dose of ipilimumab, following two serial palliative resections of dominant masses that had became ulcerated and painful
Summary
Immune checkpoint blockade using monoclonal antibodies have been approved by the US Food and Drug Administration (FDA) to treat patients with advanced melanoma. The patient was treated with a pulse of dexamethasone for 4 days at 1 mg/kg-day, with no change in his transfusion requirements and no rise of the reticulocyte count, intravenous immunoglobulin (IVIg), with no reticulocytosis and no normalization of his hemoglobin His cytogenetics showed 5/20 cells positive for del(5q), consistent with myelodysplastic syndrome and he received a course of lenalidomide between April and June 2013, which was eventually stopped 2nd to renal toxicity and substantial improvement of the anemia. During the protracted postoperative course there was further growth of multiple skin metastases with emergence of new lesions both clinically and on restaging scans while no distant metastases were evident Another palliative resection of a fast growing nodule on the right medial knee was performed in August 2014. The metastasis which was resected in February 2014 was highly necrotic with some areas of viable tumor as evident by SOX10 staining, whereas no necrosis was seen in the metastasis that was removed in August 2014
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