Medical Molecular Morphology ( IF 1.2 ) Pub Date : 2024-01-30 , DOI: 10.1007/s00795-023-00377-6
Kota Konishi 1 , Mamiko Okamoto 1 , Ryuichi Tokumitsu 1 , Mitsutake Yano 1 , Kaei Nasu 1, 2 , Eiji Kobayashi 1
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Immune checkpoint inhibitors help treat malignant melanoma, but show limited use in treating malignant vaginal melanoma, an aggressive, rare gynecological malignancy. We identified two patients treated with ipilimumab and nivolumab for vaginal melanoma; both were immunonegative for programmed cell death-ligand 1 and wild-type BRAF. Case 1, a 56-year-old female who underwent radical surgery for stage 1 malignant vaginal melanoma, experienced recurrence 15 months postoperatively. She briefly responded to ipilimumab and nivolumab combination therapy before showing disease progression. Tumor shrinkage occurred with nivolumab and local radiotherapy and, 45 months postoperatively, she survives with the melanoma. Case 2, a 50-year-old female, presented with a 4-cm blackish polypoid vaginal tumor with metastatic pelvic lymph nodes. She received ipilimumab and nivolumab combination therapy for stage III unresectable malignant vaginal melanoma. The vaginal tumor shrank after the third course of treatment, and the lymphadenopathy disappeared. The patient underwent radical surgery and is currently disease-free, using nivolumab for maintenance therapy. Both patients had immune-related adverse events coinciding with periods of high therapeutic efficacy of immune checkpoint inhibitors. Neoadjuvant therapy with immune checkpoint inhibitors and radiotherapy for immune checkpoint inhibitor resensitization may effectively treat advanced or recurrent vaginal melanoma.
中文翻译:
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纳武单抗和易普利姆玛治疗复发性或晚期恶性阴道黑色素瘤的应用:两个病例系列
免疫检查点抑制剂有助于治疗恶性黑色素瘤,但在治疗恶性阴道黑色素瘤(一种侵袭性、罕见的妇科恶性肿瘤)方面的用途有限。我们确定了两名接受伊匹单抗和纳武单抗治疗阴道黑色素瘤的患者;程序性细胞死亡配体 1 和野生型BRAF均呈免疫阴性。病例1,56岁女性,因1期恶性阴道黑色素瘤接受根治手术,术后15个月复发。在出现疾病进展之前,她对伊匹单抗和纳武单抗联合治疗有短暂的反应。纳武单抗和局部放疗使肿瘤缩小,术后 45 个月,她的黑色素瘤幸存下来。病例2,50岁女性,阴道长4厘米黑色息肉样肿瘤,盆腔淋巴结转移。她接受了伊匹单抗和纳武单抗联合治疗,治疗 III 期不可切除的恶性阴道黑色素瘤。第三个疗程后阴道肿瘤缩小,淋巴结肿大消失。该患者接受了根治性手术,目前无病,正在使用纳武单抗进行维持治疗。两名患者均出现了与免疫相关的不良事件,且恰逢免疫检查点抑制剂的高疗效期。免疫检查点抑制剂的新辅助治疗和免疫检查点抑制剂再敏化的放射治疗可以有效治疗晚期或复发性阴道黑色素瘤。