PDF(Pubmed)
Abstract：
Melanoma causes the majority of skin cancer-related deaths. Despite novel therapy options, metastatic melanoma still has a poor prognosis. Immune checkpoint inhibition (ICI) therapy has been shown to prolong overall survival in patients with advanced melanoma, but mucosal melanomas respond less favorably compared to melanomas of cutaneous origin. We report on a patient with a mucosal melanoma of the rectum diagnosed in June 2020. Since a surgical intervention in order to achieve a tumor-free situation would have required an amputation of the rectum, a neo-adjuvant systemic immunotherapy with ipilimumab and nivolumab was initiated. As restaging and colonoscopy after four doses of this combination immunotherapy showed a partial response, the patient decided against the pre-planned surgery and a maintenance therapy with nivolumab was started. Repeated colonoscopy showed a complete response after four doses of nivolumab. After ongoing ICI therapy with nivolumab and no evidence of tumor relapse, immunotherapy was stopped in July 2022 after nearly 2 years of continuous treatment. The patient remained tumor-free during further follow-up. Neo-adjuvant immunotherapy is getting more explored in advanced melanoma. By administering ICI therapy before surgical resection of an essentially operable tumor, a stronger and more diverse immunological response is supposed to be achieved. Our reported case demonstrates that this approach could also be effective in mucosal melanoma despite of its generally lower response to immunotherapy.
摘要：
黑色素瘤导致大多数皮肤癌相关的死亡。尽管有新颖的治疗选择，转移性黑色素瘤的预后仍然较差.免疫检查点抑制（ICI）治疗已被证明可以延长晚期黑色素瘤患者的总体生存期。但是与皮肤来源的黑色素瘤相比，粘膜黑色素瘤的反应较差。我们报告了2020年6月诊断为直肠粘膜黑色素瘤的患者。由于为了实现无瘤状态的外科手术需要切除直肠，我们开始了伊匹单抗和纳武单抗的新辅助全身免疫疗法.作为复诊和结肠镜检查后四个剂量的这种联合免疫疗法显示部分反应，患者决定不进行预先计划的手术,并开始使用纳武单抗进行维持治疗.重复结肠镜检查显示四个剂量的纳武单抗后完全反应。在使用nivolumab进行ICI治疗后，没有肿瘤复发的证据，经过近2年的连续治疗,免疫疗法于2022年7月停止.患者在进一步随访期间保持无瘤。新辅助免疫疗法在晚期黑色素瘤中得到了更多的探索。通过在手术切除基本可手术的肿瘤之前给予ICI治疗，应该实现更强和更多样化的免疫反应。我们报道的病例表明，尽管对免疫疗法的反应通常较低，但这种方法在粘膜黑色素瘤中也可能有效。
