Continuous systemic corticosteroids do not affect the ongoing regression of metastatic melanoma for more than two years following ipilimumab therapy
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Malignant melanoma is an aggressive skin cancer with no effective therapies currently approved for advanced disease. In the case presented, a 55-year-old female patient diagnosed with widespread disease from amelanotic desmoplastic melanoma was treated with 10 mg/kg ipilimumab as part of a phase II clinical trial (CA184-008). Prior to ipilimumab, three chemotherapeutic regimens had failed. Ipilimumab acts as a T-cell potentiator via blockade of cytotoxic T-lymphocyte antigen-4, a negative regulator of T-cell activation. Response to ipilimumab treatment was rapid, with a substantial drop in tumor volume within 12 weeks of treatment initiation. Based on the appearance of a new subcutaneous lesion, reinduction with ipilimumab was performed at Week 30. Following reinduction, the appearance of another small new lesion made the patient ineligible, as per protocol, for further dosing despite stabilization of her remaining lesions. Ipilimumab-associated immune-related adverse events were manageable with the use of treatment guidelines. It is of remarkable immunotherapeutic importance that no new lesions emerged and gradual tumor regression is still ongoing more than 2 years following the last dose of ipilimumab, despite daily administration of systemic corticosteroids to manage drug-induced AEs. The ongoing clinical response is maintained without any further antineoplastic treatment.
KeywordsIpilimumab Immunotherapy Melanoma Cytotoxic T-lymphocyte antigen-4 CTLA-4 Immune-related adverse events β-human chorionic gonadotropin
β-subunit of human chorionic gonadotropin
Cytotoxic T-lymphocyte antigen-4
Eastern Cooperative Oncology Group Performance Status
Immune-related adverse event
Sum of the perpendicular diameters of tumor
Upper limit of normal
World Health Organization
Editorial and writing assistance provided by StemScientific, funded by Bristol-Myers Squibb Company.
Acknowledgment of support
Dr. Harmankaya did not receive any research support for these studies.
KH and CE served as study coordinators for the studies described in this manuscript. HP and MB were principal investigators for the CA184-008 and CA184-025 studies, respectively. CK has nothing to disclose. RI and AH are employees of Bristol-Myers Squibb Company.
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