Abstract：
BACKGROUND: Uveal melanoma is a rare cancer, in which metastases occur in approximately one half of cases. In metastatic disease, the prognosis is unfavorable and the median of survival does not exceed 6 months. Effective treatment options were very limited up to date. Tebentafusp is a bispecific fusion protein, which as the first drug proved efficacy in uveal melanoma.
METHODS: The patient was referred for suspected uveal melanoma of the left eye. She was treated for Hodgkin\'s disease in the past. Primarily, the tumor was treated by radiosurgery with radiotherapy of a small lesion of the vertebral body. However, later the patient had to undergo bulbus enucleation with confirmation of a large tumor category pT4b. PET/CT revealed metastases of the bones and the liver; simultaneously, haplotype A*02: 01 was confirmed. The patient underwent radiotherapy of the sternum and later, after confirmation of payment from the health insurance company, she started treatment with tebentafusp. The first three doses were administered during admission to the hospital, with a need to treat cytokine release syndrome by corticosteroids. Later, the administration was performed in an out-patient regimen, without complications, except for a transient elevation of transaminases. The first CT restaging confirmed stable disease; however, the second restaging confirmed a new osteolytic lesion in the processus of Th11. Because of progression, the treatment with tebentafusp was withdrawn after 6 months. Unfortunately, the lesion could not be treated by radiotherapy. Two months later, the patient was urgently admitted to the hospital because of right-sided hemiplegia; MRI revealed bleeding metastatic lesion in the brain stem.
CONCLUSIONS: In this case report, we present the case of the first patient treated with this drug in the Czech Republic.
METHODS: The patient was referred for suspected uveal melanoma of the left eye. She was treated for Hodgkin\'s disease in the past. Primarily, the tumor was treated by radiosurgery with radiotherapy of a small lesion of the vertebral body. However, later the patient had to undergo bulbus enucleation with confirmation of a large tumor category pT4b. PET/CT revealed metastases of the bones and the liver; simultaneously, haplotype A*02: 01 was confirmed. The patient underwent radiotherapy of the sternum and later, after confirmation of payment from the health insurance company, she started treatment with tebentafusp. The first three doses were administered during admission to the hospital, with a need to treat cytokine release syndrome by corticosteroids. Later, the administration was performed in an out-patient regimen, without complications, except for a transient elevation of transaminases. The first CT restaging confirmed stable disease; however, the second restaging confirmed a new osteolytic lesion in the processus of Th11. Because of progression, the treatment with tebentafusp was withdrawn after 6 months. Unfortunately, the lesion could not be treated by radiotherapy. Two months later, the patient was urgently admitted to the hospital because of right-sided hemiplegia; MRI revealed bleeding metastatic lesion in the brain stem.
CONCLUSIONS: In this case report, we present the case of the first patient treated with this drug in the Czech Republic.
摘要：
背景：葡萄膜黑色素瘤是一种罕见的癌症，其中转移发生在大约一半的病例中。在转移性疾病中，预后不良,中位生存期不超过6个月.迄今为止，有效的治疗选择非常有限。Tebentafusp是一种双特异性融合蛋白，作为第一个在葡萄膜黑色素瘤中证明有效的药物。
方法：患者因怀疑左眼葡萄膜黑色素瘤而转诊。她过去曾接受过霍奇金病的治疗。首先,肿瘤通过放射外科治疗，并对椎体的一个小病变进行放射治疗。然而,之后,患者必须接受球部摘除术,确认为大型肿瘤pT4b.PET/CT显示骨骼和肝脏转移；同时，确认单倍型A*02:01。患者接受了胸骨放疗，后来，在健康保险公司确认付款后，她开始用Tebentafusp治疗.前三剂是在入院时服用的,需要用皮质类固醇治疗细胞因子释放综合征。稍后，给药是在门诊治疗方案中进行的，无并发症,除了转氨酶的短暂升高。第一次CT复诊证实疾病稳定；然而，第二次复诊证实Th11的一个新的溶骨性病变。因为进步，6个月后停止tebentafusp治疗.不幸的是,病灶无法通过放疗治疗。两个月后,患者因右侧偏瘫紧急入院；MRI显示脑干出血转移灶。
结论：在本案例报告中，我们介绍了捷克共和国首例使用该药物治疗的患者。
方法：患者因怀疑左眼葡萄膜黑色素瘤而转诊。她过去曾接受过霍奇金病的治疗。首先,肿瘤通过放射外科治疗，并对椎体的一个小病变进行放射治疗。然而,之后,患者必须接受球部摘除术,确认为大型肿瘤pT4b.PET/CT显示骨骼和肝脏转移；同时，确认单倍型A*02:01。患者接受了胸骨放疗，后来，在健康保险公司确认付款后，她开始用Tebentafusp治疗.前三剂是在入院时服用的,需要用皮质类固醇治疗细胞因子释放综合征。稍后，给药是在门诊治疗方案中进行的，无并发症,除了转氨酶的短暂升高。第一次CT复诊证实疾病稳定；然而，第二次复诊证实Th11的一个新的溶骨性病变。因为进步，6个月后停止tebentafusp治疗.不幸的是,病灶无法通过放疗治疗。两个月后,患者因右侧偏瘫紧急入院；MRI显示脑干出血转移灶。
结论：在本案例报告中，我们介绍了捷克共和国首例使用该药物治疗的患者。
