Case Report

Successful treatment with carboplatin and paclitaxel in melanoma progression after immune-related adverse events

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA

‡Co-first authors

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Aditi Saha‡

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA

‡Co-first authors

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Kelly M Elleson

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA

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Joseph Markowitz

*Author for correspondence: Tel.: +1 813 745 8581;

E-mail Address: joseph.markowitz@moffitt.org

https://orcid.org/0000-0003-2490-5464

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA

Department of Oncologic Sciences, Morsani School of Medicine University of South Florida, Tampa, FL 33612, USA

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Published Online:31 Jul 2023https://doi.org/10.2217/imt-2022-0213

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Abstract

The overall survival of melanoma patients has improved using antibodies targeting immune checkpoints (anti-PD-1, anti-CTLA-4 and anti-LAG-3). Systemic chemotherapy was administered in melanoma for many years with limited effectiveness. Here we report a case of a patient who experienced immune-mediated adverse effects from checkpoint blockade therapy and subsequently responded to chemotherapy. The patient presented with melanoma and paraneoplastic digital ischemia. She received a combination of ipilimumab/nivolumab and experienced G3 myocarditis, followed by melanoma progression after a steroid taper. This patient achieved a partial and durable response with platinum and taxane-based chemotherapy. This report suggests the possibility of a subset of patients who experience progression after immune-based side effects where chemotherapy may be effective in the modern age of melanoma treatment.

Plain language summary

We describe a patient with a type of skin cancer called melanoma. At first, we tried to treat it with a medication that made the patient's body's defense system fight against it, but it caused problems with her heart so we had to stop it. Instead, we used another type of treatment called chemotherapy, which worked. The patient remains off therapy 4.5 years later. The lesson learned from this case is that chemotherapy is still helpful in certain situations. The initial treatment did not stop the melanoma growth. In addition, the patient had life-threatening toxicity.

Tweetable abstract

Chemotherapy may be useful for melanoma patients intolerant to checkpoint blockade therapy. Written informed consent was obtained from the patient to publish a case report.

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Papers of special note have been highlighted as: • of interest

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Vol. 15, No. 13

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History

Received 24 August 2022

Accepted 9 June 2023

Published online 31 July 2023

Published in print September 2023

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Keywords

Financial & competing interests disclosure

J Markowitz is NIH funded; grant number KO8CA252164. Markowitz has received industry funding to the Moffitt Cancer Center unrelated to this manuscript from Morphogenesis, Jackson Laboratories, Microba, Idera Pharmaceuticals and Merck within the past 2 years. Moffitt Cancer Center has submitted a patent application on behalf of J Markowitz on work unrelated to this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

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