Rieth John M, Belzer Alex C, Walhof Mackenzie L, Milhem Mohammed M
Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA.
Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Case Rep Oncol. 2024 Aug 21;17(1):906-912. doi: 10.1159/000539979. eCollection 2024 Jan-Dec.
Leiomyosarcoma (LMS) is a malignancy with smooth muscle differentiation. Metastatic LMS is associated with poor prognosis and limited efficacy of systemic treatment. Novel treatment modalities are desperately needed for this entity.
We report the first use of pembrolizumab plus pharmacologic ascorbate in 3 patients with metastatic LMS. All cases resulted in persistent objective responses and disease control significantly better than has been reported with chemotherapy or other immunotherapeutic approaches. Three patients with metastatic LMS, one each of uterine, vascular, and soft tissue origin, were treated with pembrolizumab plus pharmacologic ascorbate. The patient with uterine LMS received combination therapy at presentation and had persistent response for 12 months, which is ongoing. The patient with metastatic LMS of the inferior vena cava received combination therapy at presentation and had persistent response for 12 months, at which time new metastases were found. The patient with soft tissue LMS had disease progression on pembrolizumab monotherapy prior to the addition of ascorbate, after which she had a 17-month response, which is ongoing. No side effects attributed to treatment were reported.
Pembrolizumab plus pharmacologic ascorbate is a novel immunotherapeutic approach and warrants further study in LMS.
平滑肌肉瘤（LMS）是一种具有平滑肌分化的恶性肿瘤。转移性LMS预后较差，全身治疗效果有限。该疾病迫切需要新的治疗方式。
我们报告了3例转移性LMS患者首次使用帕博利珠单抗联合药理剂量维生素C的情况。所有病例均产生了持续的客观反应，疾病控制情况明显优于化疗或其他免疫治疗方法所报告的情况。3例转移性LMS患者，分别起源于子宫、血管和软组织，接受了帕博利珠单抗联合药理剂量维生素C的治疗。子宫LMS患者初诊时接受联合治疗，持续缓解12个月，目前仍在持续缓解中。下腔静脉转移性LMS患者初诊时接受联合治疗，持续缓解12个月，此时发现了新的转移灶。软组织LMS患者在加用维生素C之前接受帕博利珠单抗单药治疗时病情进展，加用后缓解了17个月，目前仍在持续缓解中。未报告与治疗相关的副作用。
帕博利珠单抗联合药理剂量维生素C是一种新的免疫治疗方法，值得在LMS中进一步研究。
