Richard C Wu1,2, William Newman3, Liron Patanowitz4, Barton F Branstetter5, Nduka Amankulor3, Ahmad A Tarhini6. 1. Division of Oncology, UPMC Cancer Center, Pittsburgh, PA 15232, USA. 2. Hematology/Oncology Fellowship Program, UPMC Cancer Center, Pittsburgh, PA 15232, USA. 3. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. 4. Department of Pathology, UPMC Cancer Center, Pittsburgh, PA 15232, USA. 5. Department of Neuro-Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA. 6. Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
Abstract
Background: Leptomeningeal disease (LMD) from melanoma is rapidly fatal with median overall survival between 6.9 weeks and 3.5 months. It is not known whether immune checkpoint inhibitors have a role in treating LMD. Case presentation: We report a 33-year-old male patient who developed LMD from a BRAF V600E-mutated melanoma brain metastasis, despite prior treatment with surgical resection, radiotherapy and dabrafenib/trametinib. He underwent whole brain radiotherapy with stereotactic radiotherapy to the lumbosacral spine, and was started on nivolumab, which led to prolonged remission lasting 2 years and 3 months, before disease progression and death. Conclusion: This is the first case report to highlight a potential long-term efficacy of radiotherapy and anti-PD-1 immunotherapy, in treating LMD from metastatic melanoma that is resistant to targeted therapy.
Background: Leptomeningeal disease (LMD) from melanoma is rapidly fatal with median overall survival between 6.9 weeks and 3.5 months. It is not known whether immune checkpoint inhibitors have a role in treating LMD. Case presentation: We report a 33-year-old male patient who developed LMD from a BRAFV600E-mutated melanoma brain metastasis, despite prior treatment with surgical resection, radiotherapy and dabrafenib/trametinib. He underwent whole brain radiotherapy with stereotactic radiotherapy to the lumbosacral spine, and was started on nivolumab, which led to prolonged remission lasting 2 years and 3 months, before disease progression and death. Conclusion: This is the first case report to highlight a potential long-term efficacy of radiotherapy and anti-PD-1 immunotherapy, in treating LMD from metastatic melanoma that is resistant to targeted therapy.
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