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Cancer Immunoprevention: A Case Report Raising the Possibility of "Immuno-interception"
Jessica G Mancuso1, William D Foulkes1,2,3, Michael N Pollak4,2
1Cancer Prevention Centre, Jewish General Hospital, Montreal, Quebec, Canada.
Abstract:
Immune checkpoint blockade therapy provides substantial benefits for subsets of patients with advanced cancer, but its utility for cancer prevention is unknown. Lynch syndrome (MIM 120435) is characterized by defective DNA mismatch repair and predisposition to multiple cancers. A variant of Lynch syndrome, Muir-Torre syndrome (MIM 158320), is characterized by frequent gastrointestinal tumors and hyperplastic or neoplastic skin tumors. We report the case of a man with Muir-Torre syndrome who had 136 cutaneous or visceral hyperplastic or neoplastic lesions over a period of 19 years (mean 7.5 neoplasms/year, range 2-26) prior to receiving pembrolizumab immunotherapy as part of multi-modality treatment for invasive bladder cancer. He not only had a complete response of the bladder cancer, but also was noted to have an absence of new cancers during a 22-month follow-up period. This case adds to the rationale for exploring the utility of immune checkpoint blockade for cancer prevention, particularly for patients with DNA repair deficits.
Insights
Immune checkpoint blockade therapy may prevent new cancers in patients with Muir-Torre syndrome, a Lynch syndrome variant. A patient receiving pembrolizumab for bladder cancer showed no new tumors during follow-up, suggesting potential for cancer prevention.
Area of Science:
- Oncology
- Immunology
- Genetics
Background:
- Immune checkpoint blockade (ICB) therapy benefits some advanced cancer patients.
- Its role in cancer prevention remains unexplored.
- Lynch syndrome involves DNA mismatch repair defects, increasing cancer risk.
Observation:
- A patient with Muir-Torre syndrome (a Lynch syndrome variant) developed 136 hyperplastic or neoplastic lesions over 19 years.
- The patient received pembrolizumab immunotherapy for invasive bladder cancer.
- During 22-month follow-up post-treatment, no new cancers emerged.
Findings:
- The patient achieved a complete response for bladder cancer.
- Pembrolizumab treatment correlated with an absence of new cancer development.
- This suggests ICB may halt tumor formation in susceptible individuals.
Implications:
- This case supports investigating ICB for cancer prevention strategies.
- Patients with DNA repair deficiencies, like Muir-Torre syndrome, are potential candidates.
- Further research is warranted to explore ICB's preventative role in hereditary cancer syndromes.
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