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. 2015 May 19;3:19.
doi: 10.1186/s40425-015-0064-2. eCollection 2015.

Rapid Complete Response of Metastatic Melanoma in a Patient Undergoing Ipilimumab Immunotherapy in the Setting of Active Ulcerative Colitis

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Free PMC article

Rapid Complete Response of Metastatic Melanoma in a Patient Undergoing Ipilimumab Immunotherapy in the Setting of Active Ulcerative Colitis

A Doran Bostwick et al. J Immunother Cancer. .
Free PMC article

Abstract

While blockade of the cytotoxic T-lymphocyte antigen-4 (CTLA-4) T cell regulatory receptor has become a commonly utilized strategy in the management of advanced melanoma, many questions remain regarding the use of this agent in patient populations with autoimmune disease. We present a case involving the treatment of a patient with stage IV melanoma and ulcerative colitis (UC) with anti-CTLA-4 antibody immunotherapy. Upon initial treatment, the patient developed grade III colitis requiring tumor necrosis factor-alpha (TNF-α) blocking antibody therapy, however re-treatment with anti-CTLA-4 antibody following a total colectomy resulted in a rapid complete response accompanied by the development of a tracheobronchitis, a previously described extra-intestinal manifestation of UC. This case contributes to the evolving literature on the use of checkpoint inhibitors in patients also suffering from autoimmune disease, supports future clinical trials investigating the use of these agents in patients with autoimmune diseases, and suggests that an understanding of the specific molecular pathways involved in a patient's autoimmune pathology may provide insight into the development of more effective novel combinatorial immunotherapeutic strategies.

Keywords: Advanced melanoma; Autoimmunity; Ipilimumab; Ulcerative colitis.

Figures

Figure 1
Figure 1
Ipilimumab Treatment Course of Patient with UC. A. re-staging chest axial PET CT imaging of patient at different time points. (1) prior to initial dose of ipilimumab, (2) following first dose of ipilimumab and ipilimumab-induced grade III colitis, (3) following total colectomy and prior to re-treatment with ipilimumab, (4) complete disease resolution following a four-dose regimen of ipilimumab. B. Time line of clinical events.
Figure 2
Figure 2
Induction of Tracheobronchitis and Elevation in Absolute Lymphocyte Count Following Treatment of UC Patient with Ipilimumab. A. PET CT evidence of ipilimumab-induced tracheobronchitis in a patient with UC (arrow). B. Absolute lymphocyte count (ALC) versus treatment day in a UC patient undergoing ipilimumab immunotherapy. Arrows indicate ipilimumab dosing.

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