Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
BMC Cancer. 2017 Nov 21;17(1):778. doi: 10.1186/s12885-017-3785-4.
Pseudoprogression refers to a specific pattern of response sometimes observed in malignant melanoma patients receiving treatment with immune-checkpoint inhibitors. Although cases with pseudoprogression documented once have been reported previously, there have been no case reports yet of pseudoprogression events documented twice during treatment.
A 55-year-old man underwent surgery for locally advanced esophageal malignant melanoma and received postoperative adjuvant interferon therapy. However, he presented with multiple liver and bone metastases at 6 months after the surgery, and was initiated on treatment with nivolumab 2 mg/kg every 3 weeks as the first-line treatment for recurrent disease. Follow-up computed tomography revealed that the liver metastases initially increased transiently in size, but eventually regressed. However, while the liver metastases continued to shrink, a new peritoneal nodule emerged, that also subsequently shrinked during the course of treatment with nivolumab. With only grade 1 pruritus, the patient continues to be on nivolumab treatment at 15 months after the induction therapy, with no progression observed after the second episode of pseudoprogression in the liver and peritoneal nodule.
We present the case of a patient with metastatic malignant melanoma who showed the unique response pattern of serial pseudoprogression during treatment with nivolumab. This case serves to highlight the fact that development of a new lesion may not always signify failure of disease control during treatment with nivolumab.
假性进展是恶性黑色素瘤患者接受免疫检查点抑制剂治疗时出现的一种特定的反应模式。虽然之前有报道过一例有记录的假性进展病例，但尚无在治疗过程中记录到两次假性进展事件的病例报告。
一名 55 岁男性因局部晚期食管恶性黑色素瘤接受了手术，并接受了术后辅助干扰素治疗。然而，在手术后 6 个月时，他出现了多处肝和骨转移，并开始接受纳武利尤单抗 2mg/kg 每 3 周一次的治疗，作为复发性疾病的一线治疗。随访 CT 显示肝转移灶最初短暂增大，但最终消退。然而，当肝转移灶继续缩小的同时，新出现了一个腹膜结节，在接受纳武利尤单抗治疗过程中，该结节也随后缩小。在诱导治疗后 15 个月，患者仅出现 1 级瘙痒，继续接受纳武利尤单抗治疗，在肝和腹膜结节出现第二次假性进展后，未观察到疾病进展。
我们报告了一例转移性恶性黑色素瘤患者，在接受纳武利尤单抗治疗期间出现了连续假性进展的独特反应模式。该病例表明，在接受纳武利尤单抗治疗期间，新病灶的出现并不一定意味着疾病控制失败。
