Clinical Case: Rapid Eradication of Melanoma With a Single Dose of Immunotherapy

Patient experiences complete remission after treatment with 2 immunotherapies.

A recent trial offered a glimpse of hope for patients fighting melanoma.

In a letter to the editor of the New England Journal of Medicine dated May 21, 2015, Paul B. Chapman, MD, Sandra P. D’Angelo, MD, and Jedd D. Wolchok, MD, PhD, all of the Memorial Sloan Kettering Cancer Center in New York City, reported a case of complete remission of metastatic melanoma in a patient treated with a single dose of each of 2 immunotherapies: ipiliumab and nivolumab.

The complete remission occurred in a patient enrolled in an early phase 1 trial. Overall results of that 13-patient trial (NCT02186249) showed that more than half (53%) of patients experienced a tumor shrinkage of 80% or more.

The best response in the early trial, reported in the letter to the editor, occurred in a 49-year-old woman 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 1 study.

Before treatment, a mass of metastasized melanoma cells extended through a large portion on the underside of the woman's breasts. Three weeks later, there was no evidence of disease, including no masses visible on a CT scan.

“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,” the researchers wrote.

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,” the authors wrote. “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 1 study from which it originated bode well for the combination of nivolumab and ipilimumab in the treatment of advanced cases of metastatic melanoma. With several immunotherapies in development, finding the optimal combinations for a variety of patient types and cancer types will likely be a combination of intensive research science, and certain exceptional cases such as this one.

Reference

Chapman PB, D'Angelo SP, Wolchok JD. Rapid eradication of a bulky melanoma mass with one dose of immunotherapy. N Engl J Med. 2015;372(21):2073-2074.