Neoadjuvant Immune Checkpoint Inhibition in Metastatic Conjunctival Melanoma

Area of Science:

• Oncology
• Immunotherapy
• Ophthalmology

Background:

• Immune checkpoint inhibitors (ICI) have revolutionized advanced cutaneous melanoma treatment.
• Conjunctival melanoma is often excluded from clinical trials, limiting treatment data.
• Locally advanced and metastatic conjunctival melanoma presents significant therapeutic challenges.

Purpose of the Study:

• To report a case of successful neoadjuvant immunotherapy in a patient with advanced conjunctival melanoma.
• To evaluate the efficacy of ipilimumab and nivolumab in unresectable conjunctival melanoma.
• To suggest the potential utility of neoadjuvant ICI for conjunctival melanoma.

Main Methods:

• A patient with recurrent, unresectable, BRAF/NRAS wild-type conjunctival melanoma received 4 cycles of ipilimumab and nivolumab, followed by maintenance nivolumab.
• Tumor response was assessed via imaging and physical examination.
• The patient subsequently underwent surgical resection of residual tumor.

Main Results:

• The patient achieved a dramatic response, with significant reduction in nasal mass size and complete resolution of thoracic lymphadenopathy.
• Residual tumor size was reduced by approximately 75% prior to resection.
• The patient remained melanoma-free at 1-year follow-up.

Conclusions:

• Neoadjuvant ipilimumab and nivolumab demonstrated significant efficacy in a patient with locally advanced conjunctival melanoma.
• Conjunctival melanoma shares genetic similarities with cutaneous melanoma, supporting ICI consideration.
• ICI should be considered for patients with locally advanced or limited metastatic conjunctival melanoma.