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Successful treatment of BRAF/MEK inhibitor‐resistant advanced cutaneous melanoma with nivolumab plus ipilimumab combination therapy followed by intensity‐modulated radiotherapy
Author(s) -
Okuma Takami,
Furudate Sadanori,
Kambayashi Yumi,
Hashimoto Akira,
Aiba Setsuya,
Fujimura Taku
Publication year - 2021
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/1346-8138.15962
Subject(s) - ipilimumab , medicine , nivolumab , melanoma , radiation therapy , cancer research , oncology , combination therapy , immunotherapy , mek inhibitor , targeted therapy , kinase , cancer , mapk/erk pathway , biology , microbiology and biotechnology
BRAF kinase inhibitors in combination with MEK kinase inhibitors are among the most promising chemotherapeutic regimens for the treatment of advanced BRAF‐mutant melanoma. Although the NCCN guideline for cutaneous melanoma recommended BRAF/MEK inhibitors as first‐line therapies for unresectable BRAF‐mutated melanoma, resistance to these drugs should be taken into account in real‐world practice. Therefore, development of a protocol for BRAF/MEK inhibitor‐resistant advanced melanoma is needed. In this report, a case of BRAF/MEK inhibitor‐resistant advanced cutaneous melanoma that was successfully treated with nivolumab plus ipilimumab combination therapy followed by intensity‐modulated radiotherapy (IMRT) is reported. In the present case, not only the locally irradiated lesion, but remote metastases including inguinal lymph nodes decreased after ipilimumab plus nivolumab followed by IMRT treatment leading to complete remission, suggesting that IMRT triggered an abscopal response. Moreover, immunohistochemical analysis showed increased CD3 + , CD4 + , and CD8 + T cells after radio‐immunotherapy (RIT). This case suggests that RIT might break the tolerance in the tumor microenvironment and induce a systemic anti‐melanoma immune response.