Pseudoprogression with Neoadjuvant Immunotherapy for Cutaneous Melanoma

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICI) have revolutionized metastatic melanoma treatment, improving patient survival.
• Assessing treatment response can be challenging due to pseudoprogression, a transient tumor size increase caused by immune cell infiltration.
• Pseudoprogression occurs in 5-10% of metastatic patients, often preceding tumor regression.

Observation:

• This report details a case of pseudoprogression in a patient with a large retroauricular melanoma and lymph node involvement treated with ipilimumab and nivolumab.
• The initial assessment showed increased lesion size and inflammatory features, characteristic of pseudoprogression.
• Pathological examination after 3 months revealed complete regression, with the patient remaining disease-free for 14 months.

Findings:

• The study documents a case of pseudoprogression during neoadjuvant ICI therapy for cutaneous melanoma.
• The observed pseudoprogression was followed by a complete pathological response and sustained disease-free survival.
• The patient experienced a dramatic clinical improvement after the initial pseudoprogression phase.

Implications:

• This case suggests that pseudoprogression might be more common in superficial lesions, which are amenable to physical examination.
• Understanding pseudoprogression is crucial for accurate treatment response assessment in melanoma patients receiving ICI.
• Neoadjuvant ICI therapy shows promise for durable pathological responses in cutaneous melanoma.