Durable Complete Response in a Melanoma Patient With Unknown Primary, Associated With Sequential and Severe Multi-Organ Toxicity After a Single Dose of CTLA-4 Plus PD-1 Blockade: A Case Report

• Main Authors: Johanna Matull, Elisabeth Livingstone, Axel Wetter, Lisa Zimmer, Anne Zaremba, Harald Lahner, Dirk Schadendorf, Selma Ugurel
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-11-01
• Series: Frontiers in Oncology
• Subjects: checkpoint inhibitors; melanoma; immune-related adverse events; therapy discontinuation; case report
• Online Access: https://www.frontiersin.org/articles/10.3389/fonc.2020.592609/full
• ISSN: 2234-943X

Monoclonal antibodies blocking PD-1 and CTLA-4 immunological checkpoints lead to durable tumor responses in a considerable number of advanced melanoma patients. Besides their anti-neoplastic efficacy, these immune checkpoint inhibitors cause a wide range of immune-related adverse events (irAEs), often enforcing an early discontinuation of therapy. The value of irAEs as a predictive marker for better patient survival is still debated. We report here on a melanoma patient with intramuscular, pulmonary, and bone metastases who developed severe sequential irAEs involving multiple organ systems after single application of a combined immunotherapy with ipilimumab plus nivolumab, followed by a durable complete response despite an early discontinuation of therapy.