Departments of Dermatology, Venerology and Allergology.
Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Anticancer Drugs. 2018 Oct;29(9):914-918. doi: 10.1097/CAD.0000000000000664.
In this case report, we describe a patient with an inoperable mucosal melanoma of the sinonasal cavity who achieved an ongoing complete response to combined immunotherapy with ipilimumab and nivolumab after initial pseudoprogression. Despite massive enlargement of the tumor 9 weeks after treatment initiation, we decided to continue with checkpoint inhibitor immunotherapy because of lacking potent therapeutic alternatives and the possibility of pseudoprogression. In the computed tomography scan 3 months later, the tumor was no longer detectable. To date, the patient is still in remission. However, she developed severe immune-related thrombocytopenia and neutropenia that are rarely encountered with checkpoint inhibitor immunotherapy. Thrombocytopenia did not respond to corticosteroids, but rapidly improved after the administration of single-dose intravenous immunoglobulin. This exceptional case highlights the effectiveness of combined immunotherapy with ipilimumab and nivolumab in mucosal melanoma, the phenomenon of pseudoprogression, as well as the rare event of immune-related hematological side effects.
在本病例报告中，我们描述了一名鼻腔鼻窦黏膜黑色素瘤不可手术的患者，在初始假性进展后接受伊匹单抗和纳武单抗联合免疫治疗后持续获得完全缓解。尽管在治疗开始后 9 周肿瘤明显增大，我们还是决定继续使用检查点抑制剂免疫治疗，因为缺乏有效的治疗选择和假性进展的可能性。在 3 个月后的计算机断层扫描中，肿瘤已无法检测到。迄今为止，该患者仍处于缓解状态。然而，她出现了严重的免疫相关血小板减少和中性粒细胞减少，这在检查点抑制剂免疫治疗中很少见。血小板减少对皮质类固醇没有反应，但在单次静脉注射免疫球蛋白治疗后迅速改善。这个特殊病例突出了伊匹单抗和纳武单抗联合免疫治疗在黏膜黑色素瘤中的有效性、假性进展现象以及免疫相关血液学副作用的罕见事件。
