[EVALUATION OF THE EFFICASY OF THE DRUG OPDIVO (NIVOLUMAB) IN A PATIENT DIAGNOSED WITH UNRESECTABLE SKIN MELANOMA,...

The case was analyzed for response to nivolumab (Opdivo) monotherapy in a patient with recurrent skin melanoma (10x6x6 cm) and disease dissemination (with multiple lung metastasis), positive for BRAF mutation that followed upon the local therapy (surgical excision) and 6 cycles of adjuvant chemotherapy (at CVD regimen - cisplatin, vinblastine, dacarbazine). Histological results: melanoma. Immunohystochemical: S 100-positive; Melan A - positive; HMB45 - positive, AE1/AE3 - negative, p53 - positive in most cells, vim - positive, ɑ sma - weak in most cells, Ki67 - positive in 20%, BRAFmut, ECOG performance status 1, LDH - 1320 U/L (N <308 U/L). The effective treatment available for metastatic or unresectable melanoma, Opdivo (nivolumab) was given at a dose of 240 mg every two weeks. Overall, 5 courses were indicated. Local recurrence of melanoma at the site of the primary excision began to resolve after 3 courses of immunotherapy with checkpoint inhibitor (nivolumab) which led to a significant decrease in the size of the cancer. And 5 courses of nivolumab therapy demonstrated complete regression of local recurrence and multiple lung metastases. No locoregional recurrence was found on MRI of the neck area. The patient's condition is now satisfactory. She doesn't feel pain and refuses to take pain relievers, leads an active lifestyle (ECOG 0). Serum level of LDH is within normal limits. Currently, the targeted therapy with low molecular weight selective inhibitors of mutant BRAF (vemurafenib, dabrafenib) and immune checkpoint blockers (nivolumab, pembrolizumab) is generally recommended for unresectable skin melanoma patients bearing BRAF mutations. Despite this dual treatment strategy, the use of even one nivolumab (in monoregimen), showed complete regression of both - the local recurrence and multiple lung metastases in the case of a positive BRAF mutation and substantially improved the survival of inoperable cancer patient.