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Case Reports
. 2023 Jan 10;18(2):8.
doi: 10.3892/mco.2023.2604. eCollection 2023 Feb.

Potential dual synergy between electrochemotherapy and sequence of immunotherapies in metastatic melanoma: A case report

Francesca Morgese  1 , Francesco De Feudis  2 , Paolo Balercia  2 , Rossana Berardi  1
Affiliations
Case Reports

Potential dual synergy between electrochemotherapy and sequence of immunotherapies in metastatic melanoma: A case report

Francesca Morgese et al. Mol Clin Oncol. .

Abstract

Immune checkpoint inhibitors have changed the natural history of advanced melanoma. Despite this, a notable proportion of patients immediately relapse or develop resistance during immunotherapy, especially with the appearance of superficial metastases and consequently with a dramatic impact on clinical outcomes. Local treatment by electrochemotherapy (ECT), parallel to regional control with palliative aim, seems to release neoantigens potentially determining a significant systemic anticancer immune reactivation. The present study reported a case of a patient with metastatic melanoma receiving Pembrolizumab, electrochemotherapy and then Ipilimumab for in-transit and finally locoregional lymph nodes and distant bone metastases with experience of clinic-radiological remission. Specifically, the present patient progressed during adjuvant treatment with in-transit metastases on the scalp; he underwent two cycle of ECT obtaining partial and then unexpected and very fast nearly complete response with the Ipilimumab treatment. Concomitantly, he developed grade 4 endocrine adverse events (hypophysitis and diabetes mellitus type I) as immune-related toxicities. At 12 months from ECT the patient is in ECOG Performance Status 0 and he has resumed a regular social life. In our experience, ECT in two administrations increased and accelerated the response of Ipilimumab. The present confirmed its promising contribution in inducing a powerful immune response in order to overcome primary or acquired resistance to immune checkpoint inhibitors such as anti-programmed death antigen-1 drugs.

Keywords: electrochemotherapy; immunotherapy; in-transit melanoma metastasis; very fast response.

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Conflict of interest statement

FM was a consultant/advisory board member for BMS and MSD. The rest of the authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Frontal view of the patient's scalp before and after the ECT. (A) June 2021 baseline. (B) August 2021 after first ECT administration. The circles indicate refractory metastasis. (C) October 2021 after second ECT administration. ECT, electrochemotherapy.
Figure 2
Figure 2
Left profile of the patient before and after the ECT. (A) June 2021 baseline. (B) August 2021 after first ECT administration. (C) October 2021 after second ECT administration. ECT, electrochemotherapy.
Figure 3
Figure 3
Right profile of the patient before and after the ECT. (A) June 2021 baseline. (B) August 2021 after first ECT administration. (C) October 2021 after second ECT administration. ECT, electrochemotherapy.
Figure 4
Figure 4
Evidence of liver angioma reduction (with yellow line) during immunotherapy on CT scan. (A) Abdomen CT scan of June 2021. (B) Abdomen CT scan of September 2021. CT, computerized tomography.
Figure 5
Figure 5
Right iliac bone metastasis on PET-CT scan of October 2021. PET-CT, positron emission tomography-computerized tomography.
Figure 6
Figure 6
Disappearance of pathological uptake of right iliac bone on PET-CT scan of February 2022. PET-CT, positron emission tomography-computerized tomography.
Figure 7
Figure 7
Clinical remission of disease on the scalp. Presence of vitiligo on the (A) right profile, (B) frontal view and (C) left profile.
See this image and copyright information in PMC

References

    1. Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363:711–723. doi: 10.1056/NEJMoa1003466. - DOI - PMC - PubMed
    1. Larkin J, Chiarion-Sileni V, Gonzalez R, Grob JJ, Rutkowski P, Lao CD, Cowey CL, Schadendorf D, Wagstaff J, Dummer R, et al. Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2019;381:1535–1546. doi: 10.1056/NEJMoa1910836. - DOI - PubMed
    1. Weber J, Mandala M, Del Vecchio M, Gogas HJ, Arance AM, Cowey CL, Dalle S, Schenker M, Chiarion-Sileni V, Marquez-Rodas I, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377:1824–1835. doi: 10.1056/NEJMoa1709030. - DOI - PubMed
    1. Eggermont AMM, Blank CU, Mandalà M, Long GV, Atkinson VG, Dalle S, Haydon AM, Meshcheryakov A, Khattak A, Carlino MS, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma (EORTC 1325-MG/KEYNOTE-054): Distant metastasis-free survival results from a double-blind, randomised, controlled, phase 3 trial. Lancet Oncol. 2021;22:643–654. doi: 10.1016/S1470-2045(21)00065-6. - DOI - PubMed
    1. Robert C, Ribas A, Schachter J, Arance A, Grob JJ, Mortier L, Daud A, Carlino MS, McNeil CM, Lotem M, et al. Pembrolizumab versus ipilimumab in advanced melanoma (KEYNOTE-006): Post-hoc 5-year results from an open-label, multicentre, randomised, controlled, phase 3 study. Lancet Oncol. 2019;20:1239–1251. doi: 10.1016/S1470-2045(19)30388-2. - DOI - PubMed

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