Abscopal Effect in a Stage IV Melanoma Patient who Progressed on Pembrolizumab

In this case report, we present the clinical course of a woman with locally advanced mucosal melanoma of the oral cavity. She was initially treated with surgery with adjuvant local radiation of 50 Gy in 20 fractions. She quickly relapsed with an aggressive regional recurrence of the disease on the n...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2018-02, Vol.10 (2), p.e2238
Main Authors: Tsui, James M, Mihalcioiu, Catalin, Cury, Fabio L
Format: Article
Language:English
Subjects:
Allergy/Immunology
Cancer therapies
Case reports
Clinical trials
Hospitals
Immunotherapy
Medical imaging
Melanoma
Metastasis
Monoclonal antibodies
Mouth
Neck
NMR
Nuclear magnetic resonance
Oncology
Ostomy
Patients
Radiation Oncology
Radiation therapy
Skin cancer
Targeted cancer therapy
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Summary:In this case report, we present the clinical course of a woman with locally advanced mucosal melanoma of the oral cavity. She was initially treated with surgery with adjuvant local radiation of 50 Gy in 20 fractions. She quickly relapsed with an aggressive regional recurrence of the disease on the neck and with numerous pulmonary metastases. Immunotherapy with pembrolizumab was started, with initial good response and reduction in the size of the lesion in the neck. The regression, however, was short-lived, as the mass quickly grew at a remarkable rate and the lung lesions progressed significantly. Palliative local radiation of 24 Gy in three fractions delivered at days zero, seven, and 21 to the neck mass was eventually given with the goal to alleviate symptoms. An immediate tumor regression was observed after the first fraction of radiotherapy. Remarkably, the lung lesions had also started regressing following radiation. We believe this to be a case of abscopal effect witnessed during the delivery of radiotherapy. A review of the recent literature is also presented here.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.2238