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Tumor control with PD-1 inhibition in a patient with concurrent metastatic melanoma and renal cell carcinoma.

Marmarelis ME, Davis MR, Sethi NS, Krajewksi KM, McKay RR, Choueiri TK, Ott PA - J Immunother Cancer (2016)

Bottom Line: Blockade of the immunological checkpoint programmed death 1 (PD-1) using monoclonal antibodies has shown robust anti-tumor activity across a broad range of solid and hematological malignancies including melanoma and renal cell carcinoma (RCC).Characteristic markers such as the presence of tumor infiltrating lymphocytes, PD-L1 status, and mutational load may be equally or even more important in predicting clinical benefit from PD-1 pathway blockade than tumor histology.This case of a patient with concurrent metastatic melanoma and metastatic RCC, both of which were controlled for more than a year after a single dose of the anti-PD-1 antibody pembrolizumab, illustrates the potential to simultaneously treat distinct immunogenic tumors with anti-PD-1 agents.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA USA.

ABSTRACT
Blockade of the immunological checkpoint programmed death 1 (PD-1) using monoclonal antibodies has shown robust anti-tumor activity across a broad range of solid and hematological malignancies including melanoma and renal cell carcinoma (RCC). Characteristic markers such as the presence of tumor infiltrating lymphocytes, PD-L1 status, and mutational load may be equally or even more important in predicting clinical benefit from PD-1 pathway blockade than tumor histology. This case of a patient with concurrent metastatic melanoma and metastatic RCC, both of which were controlled for more than a year after a single dose of the anti-PD-1 antibody pembrolizumab, illustrates the potential to simultaneously treat distinct immunogenic tumors with anti-PD-1 agents.

No MeSH data available.


Related in: MedlinePlus

a PET CT demonstrating FDG uptake in an enlarged mediastinal lymph nodes, small right lower lobe lung nodule, exophytic heterogenous mass in left kidney and a 3.5 × 3.2 cm vertebral mass at T3 with SUV of 11.4. b Enhanced CT view of the T3 vertebral mass
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Fig2: a PET CT demonstrating FDG uptake in an enlarged mediastinal lymph nodes, small right lower lobe lung nodule, exophytic heterogenous mass in left kidney and a 3.5 × 3.2 cm vertebral mass at T3 with SUV of 11.4. b Enhanced CT view of the T3 vertebral mass

Mentions: A 73-year-old man was diagnosed with T1a melanoma arising from the right shoulder in 2009. He underwent a wide excision and sentinel lymph node biopsy. Pathology review revealed a 1.64 mm melanoma, anatomic level deep III/early IV, no ulceration, 1 mitosis/mm2. Four right axillary sentinel lymph nodes were negative for involvement with melanoma. In September 2013, after experiencing hematuria, the patient underwent a cystoscopy followed by transurethral resection of a bladder tumor (TURBT), which revealed a low-grade urothelial carcinoma with no evidence of bladder invasion. He is a lifelong non-smoker. A staging computerized tomography (CT) scan revealed two right lower lobe lung nodules (2.7 cm and <1 cm), and a 6.3 cm tumor in the left kidney. A positron emission tomography computerized tomography (PET/CT) in November 2013 (Fig. 1) showed enlarged mediastinal lymph nodes in addition to FDG uptake in the lung nodules and a complex left kidney mass. A mass in the thoracic spine (T3 vertebra) and a small focus of uptake in the right sacral ala were also noted (Fig. 2). A biopsy of the T3 vertebral lesion was performed and pathologic review demonstrated RCC. A core needle biopsy of one of the right lower lobe lung nodules was also performed and unexpectedly revealed recurrent metastatic melanoma (Fig. 3). In December 2013, a brain MRI showed a subcentimeter left temporal metastasis. The patient received radiation to the T3 vertebral metastasis and stereotactic radiosurgery to the brain metastasis.Fig. 1


Tumor control with PD-1 inhibition in a patient with concurrent metastatic melanoma and renal cell carcinoma.

Marmarelis ME, Davis MR, Sethi NS, Krajewksi KM, McKay RR, Choueiri TK, Ott PA - J Immunother Cancer (2016)

a PET CT demonstrating FDG uptake in an enlarged mediastinal lymph nodes, small right lower lobe lung nodule, exophytic heterogenous mass in left kidney and a 3.5 × 3.2 cm vertebral mass at T3 with SUV of 11.4. b Enhanced CT view of the T3 vertebral mass
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837591&req=5

Fig2: a PET CT demonstrating FDG uptake in an enlarged mediastinal lymph nodes, small right lower lobe lung nodule, exophytic heterogenous mass in left kidney and a 3.5 × 3.2 cm vertebral mass at T3 with SUV of 11.4. b Enhanced CT view of the T3 vertebral mass
Mentions: A 73-year-old man was diagnosed with T1a melanoma arising from the right shoulder in 2009. He underwent a wide excision and sentinel lymph node biopsy. Pathology review revealed a 1.64 mm melanoma, anatomic level deep III/early IV, no ulceration, 1 mitosis/mm2. Four right axillary sentinel lymph nodes were negative for involvement with melanoma. In September 2013, after experiencing hematuria, the patient underwent a cystoscopy followed by transurethral resection of a bladder tumor (TURBT), which revealed a low-grade urothelial carcinoma with no evidence of bladder invasion. He is a lifelong non-smoker. A staging computerized tomography (CT) scan revealed two right lower lobe lung nodules (2.7 cm and <1 cm), and a 6.3 cm tumor in the left kidney. A positron emission tomography computerized tomography (PET/CT) in November 2013 (Fig. 1) showed enlarged mediastinal lymph nodes in addition to FDG uptake in the lung nodules and a complex left kidney mass. A mass in the thoracic spine (T3 vertebra) and a small focus of uptake in the right sacral ala were also noted (Fig. 2). A biopsy of the T3 vertebral lesion was performed and pathologic review demonstrated RCC. A core needle biopsy of one of the right lower lobe lung nodules was also performed and unexpectedly revealed recurrent metastatic melanoma (Fig. 3). In December 2013, a brain MRI showed a subcentimeter left temporal metastasis. The patient received radiation to the T3 vertebral metastasis and stereotactic radiosurgery to the brain metastasis.Fig. 1

Bottom Line: Blockade of the immunological checkpoint programmed death 1 (PD-1) using monoclonal antibodies has shown robust anti-tumor activity across a broad range of solid and hematological malignancies including melanoma and renal cell carcinoma (RCC).Characteristic markers such as the presence of tumor infiltrating lymphocytes, PD-L1 status, and mutational load may be equally or even more important in predicting clinical benefit from PD-1 pathway blockade than tumor histology.This case of a patient with concurrent metastatic melanoma and metastatic RCC, both of which were controlled for more than a year after a single dose of the anti-PD-1 antibody pembrolizumab, illustrates the potential to simultaneously treat distinct immunogenic tumors with anti-PD-1 agents.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA USA.

ABSTRACT
Blockade of the immunological checkpoint programmed death 1 (PD-1) using monoclonal antibodies has shown robust anti-tumor activity across a broad range of solid and hematological malignancies including melanoma and renal cell carcinoma (RCC). Characteristic markers such as the presence of tumor infiltrating lymphocytes, PD-L1 status, and mutational load may be equally or even more important in predicting clinical benefit from PD-1 pathway blockade than tumor histology. This case of a patient with concurrent metastatic melanoma and metastatic RCC, both of which were controlled for more than a year after a single dose of the anti-PD-1 antibody pembrolizumab, illustrates the potential to simultaneously treat distinct immunogenic tumors with anti-PD-1 agents.

No MeSH data available.


Related in: MedlinePlus