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Published on: October 16, 2016
A case report of using nivolumab for a malignant melanoma patient with rheumatoid arthritis
Shun-Ichiro Kageyama1, Shigeo Yamaguchi1, Shin Ito2
11Department of Clinical Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan.
Abstract:
The use of antibodies against programmed cell death 1 (PD-1), which block inhibitory T cell checkpoints, is a promising new therapy for advanced malignant melanoma and NSCLC. However, patients with autoimmune diseases were excluded at the clinical trial using such immune checkpoint inhibitor, because of the possibilities to worsen an adverse event of the autoimmune disease. Thus, the efficacy and toxicity of nivolumab using such cases have not been reported yet. A 70-year-old woman with bone and duodenal metastasis of primary mucosal melanoma with complications of the rheumatoid arthritis was treated with nivolumab. After 4 weeks injection of nivolumab, bone metastasis was diminished. After receiving six courses of nivolumab therapy, she maintained a complete response for 9 months, without rheumatic exacerbation or drug-related adverse events. Establishment of the biomarker of the effect prediction of the PD-1 antibody, the adverse event prediction will be important in future.
Insights
Nivolumab, a programmed cell death 1 (PD-1) inhibitor, shows promise for treating advanced cancers. This study reports successful nivolumab treatment in a patient with melanoma and rheumatoid arthritis, demonstrating efficacy without adverse events.
Area of Science:
- Oncology
- Immunology
- Rheumatology
Background:
- Programmed cell death 1 (PD-1) inhibitors are emerging cancer therapies.
- Patients with autoimmune diseases were excluded from trials due to safety concerns.
- Efficacy and toxicity data for PD-1 inhibitors in autoimmune patients were lacking.
Observation:
- A 70-year-old woman with metastatic mucosal melanoma and rheumatoid arthritis received nivolumab.
- Bone metastasis showed diminished size after 4 weeks of nivolumab therapy.
- The patient achieved a complete response lasting 9 months.
Findings:
- Nivolumab treatment led to significant tumor reduction in metastatic melanoma.
- The patient experienced no worsening of rheumatoid arthritis or drug-related adverse events.
- Complete response was maintained for 9 months post-treatment.
Implications:
- Nivolumab may be a viable treatment option for cancer patients with autoimmune conditions.
- Further research is needed to establish predictive biomarkers for PD-1 inhibitor efficacy and toxicity.
- This case highlights the potential for immune checkpoint inhibitors in a broader patient population.
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