Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA.
J Immunother Cancer. 2018 Nov 19;6(1):122. doi: 10.1186/s40425-018-0437-4.
Immune-directed therapies have become front-line therapy for melanoma and are transforming the management of advanced disease. In refractory cases, multi-modal immunoncology (IO) approaches are being utilized, including combining immune checkpoint blockade (ICB) with oncolytic herpes viruses. Talimogene laherparepvec (T-VEC) is the first genetically modified oncolytic viral therapy (OVT) approved for the treatment of recurrent and unresectable melanoma. The use of IO in patients with concomitant malignancies and/or compromised immune systems is limited due to systematic exclusion from clinical trials. For example, a single case report of a solid organ transplant patient successfully treated with T-VEC for metastatic melanoma has been reported. Furthermore, the use of ICB in T-cell malignancies is limited and paradoxical worsening has been described. To our knowledge, this is the first report of dual ICB/T-VEC being administered to a patient with concurrent primary cutaneous anaplastic large cell lymphoma (pcALCL) and melanoma.
Here we present the case of a patient with concomitant primary cutaneous ALCL and metastatic melanoma, progressing on anti-programmed death (PD)-1 therapy, who developed Kaposi's varicelliform eruption after receiving the first dose of Talimogene laherparepvec.
This case highlights the complexities of care of patients with coexistent cancers, demonstrates rapid progression of primary cutaneous ALCL on nivolumab and introduces a novel adverse effect of Talimogene laherparepvec.
免疫导向疗法已成为黑色素瘤的一线治疗方法，并正在改变晚期疾病的管理方式。在难治性病例中，正在采用多模态免疫肿瘤学（IO）方法，包括将免疫检查点阻断（ICB）与溶瘤单纯疱疹病毒联合使用。替莫唑胺拉帕替尼（T-VEC）是第一种获准用于治疗复发性和不可切除性黑色素瘤的基因修饰溶瘤病毒疗法（OVT）。由于系统地从临床试验中排除，IO 在伴有恶性肿瘤和/或免疫系统受损的患者中的应用受到限制。例如，已经报道了一例实体器官移植患者成功接受 T-VEC 治疗转移性黑色素瘤的单一病例报告。此外，ICB 在 T 细胞恶性肿瘤中的应用受到限制，并描述了矛盾性恶化。据我们所知，这是首例同时给予患者 ICB/T-VEC 的病例，该患者同时患有原发性皮肤间变性大细胞淋巴瘤（pcALCL）和黑色素瘤。
这里我们介绍了一例同时患有原发性皮肤 ALCL 和转移性黑色素瘤的患者，该患者在接受抗程序性死亡（PD）-1 治疗后进展，在接受替莫唑胺拉帕替尼第一剂后出现卡波西水痘样疹。
该病例突出了同时患有癌症的患者的护理复杂性，表明原发性皮肤 ALCL 在纳武利尤单抗治疗下迅速进展，并介绍了替莫唑胺拉帕替尼的一种新的不良反应。
