Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis
Prognosis for metastatic melanoma has improved significantly with the use of immune checkpoint inhibitors. Given improvements in survival, aggressive surgical treatment may be considered in patients with life-threatening complications from their disease that would not otherwise be considered in adva...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-01-01
|
| Series: | Case Reports in Oncological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/8095601 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832565525746548736 |
|---|---|
| author | Zachary Benson Sarah Gordon Patricia Nicolato Andrew Poklepovic |
| author_facet | Zachary Benson Sarah Gordon Patricia Nicolato Andrew Poklepovic |
| author_sort | Zachary Benson |
| collection | DOAJ |
| description | Prognosis for metastatic melanoma has improved significantly with the use of immune checkpoint inhibitors. Given improvements in survival, aggressive surgical treatment may be considered in patients with life-threatening complications from their disease that would not otherwise be considered in advanced disease. Patients with preexisting autoimmune diseases or prior immune-related adverse events from therapy are largely excluded from clinical trials. Concerns exist that immunotherapy in these patients could worsen autoimmune disease or increase the risk of developing additional immune-related adverse events on therapy. We present a case of a patient with rheumatoid arthritis that presented with obstructive heart failure secondary to melanoma that had metastasized to the right atrium. After aggressive surgical resection to stabilize him from his life-threatening heart failure, he was treated with ipilimumab, which was stopped due to an immune-related adverse event. He was then started on pembrolizumab and had a durable response to therapy. Aggressive surgical treatment should be considered in patients with a cancer that may respond to immunotherapy. Furthermore, some patients with preexisting autoimmune disease may be safely treated with checkpoint inhibition therapy, and patients with a severe immune toxicity from one class may successfully be treated with an alternate class. |
| format | Article |
| id | doaj-art-b16a33842b954c65877d830f5eda331a |
| institution | Kabale University |
| issn | 2090-6706 2090-6714 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Oncological Medicine |
| spelling | doaj-art-b16a33842b954c65877d830f5eda331a2025-02-03T01:07:27ZengWileyCase Reports in Oncological Medicine2090-67062090-67142017-01-01201710.1155/2017/80956018095601Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid ArthritisZachary Benson0Sarah Gordon1Patricia Nicolato2Andrew Poklepovic3Virginia Commonwealth University, 1250 E. Marshall Street, Richmond, VA 23219, USAVirginia Commonwealth University, 1250 E. Marshall Street, Richmond, VA 23219, USAVirginia Commonwealth University, 1250 E. Marshall Street, Richmond, VA 23219, USAVirginia Commonwealth University, 1250 E. Marshall Street, Richmond, VA 23219, USAPrognosis for metastatic melanoma has improved significantly with the use of immune checkpoint inhibitors. Given improvements in survival, aggressive surgical treatment may be considered in patients with life-threatening complications from their disease that would not otherwise be considered in advanced disease. Patients with preexisting autoimmune diseases or prior immune-related adverse events from therapy are largely excluded from clinical trials. Concerns exist that immunotherapy in these patients could worsen autoimmune disease or increase the risk of developing additional immune-related adverse events on therapy. We present a case of a patient with rheumatoid arthritis that presented with obstructive heart failure secondary to melanoma that had metastasized to the right atrium. After aggressive surgical resection to stabilize him from his life-threatening heart failure, he was treated with ipilimumab, which was stopped due to an immune-related adverse event. He was then started on pembrolizumab and had a durable response to therapy. Aggressive surgical treatment should be considered in patients with a cancer that may respond to immunotherapy. Furthermore, some patients with preexisting autoimmune disease may be safely treated with checkpoint inhibition therapy, and patients with a severe immune toxicity from one class may successfully be treated with an alternate class.http://dx.doi.org/10.1155/2017/8095601 |
| spellingShingle | Zachary Benson Sarah Gordon Patricia Nicolato Andrew Poklepovic Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis Case Reports in Oncological Medicine |
| title | Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis |
| title_full | Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis |
| title_fullStr | Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis |
| title_full_unstemmed | Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis |
| title_short | Immunotherapy for Metastatic Melanoma with Right Atrial Involvement in a Patient with Rheumatoid Arthritis |
| title_sort | immunotherapy for metastatic melanoma with right atrial involvement in a patient with rheumatoid arthritis |
| url | http://dx.doi.org/10.1155/2017/8095601 |
| work_keys_str_mv | AT zacharybenson immunotherapyformetastaticmelanomawithrightatrialinvolvementinapatientwithrheumatoidarthritis AT sarahgordon immunotherapyformetastaticmelanomawithrightatrialinvolvementinapatientwithrheumatoidarthritis AT patricianicolato immunotherapyformetastaticmelanomawithrightatrialinvolvementinapatientwithrheumatoidarthritis AT andrewpoklepovic immunotherapyformetastaticmelanomawithrightatrialinvolvementinapatientwithrheumatoidarthritis |