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Konishi K, Okamoto M, Tokumitsu R, Yano M, Nasu K, Kobayashi E. Usage of nivolumab and ipilimumab for recurrent or advanced malignant vaginal melanoma: a two-case series. Med Mol Morphol 2024; 57:83-90. [PMID: 38289480 PMCID: PMC11128387 DOI: 10.1007/s00795-023-00377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 05/27/2024]
Abstract
Immune checkpoint inhibitors help treat malignant melanoma, but show limited use in treating malignant vaginal melanoma, an aggressive, rare gynecological malignancy. We identified two patients treated with ipilimumab and nivolumab for vaginal melanoma; both were immunonegative for programmed cell death-ligand 1 and wild-type BRAF. Case 1, a 56-year-old female who underwent radical surgery for stage 1 malignant vaginal melanoma, experienced recurrence 15 months postoperatively. She briefly responded to ipilimumab and nivolumab combination therapy before showing disease progression. Tumor shrinkage occurred with nivolumab and local radiotherapy and, 45 months postoperatively, she survives with the melanoma. Case 2, a 50-year-old female, presented with a 4-cm blackish polypoid vaginal tumor with metastatic pelvic lymph nodes. She received ipilimumab and nivolumab combination therapy for stage III unresectable malignant vaginal melanoma. The vaginal tumor shrank after the third course of treatment, and the lymphadenopathy disappeared. The patient underwent radical surgery and is currently disease-free, using nivolumab for maintenance therapy. Both patients had immune-related adverse events coinciding with periods of high therapeutic efficacy of immune checkpoint inhibitors. Neoadjuvant therapy with immune checkpoint inhibitors and radiotherapy for immune checkpoint inhibitor resensitization may effectively treat advanced or recurrent vaginal melanoma.
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Affiliation(s)
- Kota Konishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
| | - Mamiko Okamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
| | - Ryuichi Tokumitsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
| | - Mitsutake Yano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan.
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
- Division of Obstetrics and Gynecology, Support System for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
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Bai S, Wu Q, Song L, Wu W. Treatment of primary vaginal malignant melanoma and review of previous literature: A case report. Medicine (Baltimore) 2023; 102:e36128. [PMID: 38065883 PMCID: PMC10713139 DOI: 10.1097/md.0000000000036128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Primary vaginal malignant melanoma is a rare gynecological malignant tumor with high malignancy and poor prognosis. Because of its insidious incidence, it is generally diagnosed in the late stage, and the 5-year survival rate is only 5% to 25%. Due to the rarity of this disease and the limited number of related cases reported in the literature, there is currently no unified standard for its diagnosis and treatment. Therefore, the treatment of this disease has always been a difficult problem in clinical practice. PATIENT CONCERNS A 56-year-old woman was admitted to our hospital with discomfort in the lower abdomen. DIAGNOSIS The final diagnosis of this patient was vaginal malignant melanoma (T4N1M0). INTERVENTIONS The patient underwent extensive hysterectomy, bilateral adnexectomy, pelvic lymph node resection, and total vaginectomy. Following the surgery, the patient received adjuvant chemotherapy. OUTCOMES The patient was followed up regularly. No recurrence or metastasis has been reported to date. CONCLUSION The treatment of primary vaginal malignant melanoma is still dominated by surgery, while radiotherapy and chemotherapy are controversial. Immunotherapy and targeted therapy highlight certain advantages in advanced patients, which still need to be verified by large sample studies, We provide a case of postoperative adjuvant chemotherapy for vaginal malignant melanoma. So far, no signs of disease recurrence have been found. As the price of chemotherapy drugs decreases, it is economically convenient and acceptable for most patients, but its effectiveness needs to be observed in large-scale clinical trials.
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Affiliation(s)
- Suning Bai
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Qi Wu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Liyun Song
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Wenfei Wu
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
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Min Q, Shi Y, Wang T, Zhao H. Primary vaginal malignant melanoma: A rare case report. Asian J Surg 2023; 46:5157-5158. [PMID: 37422391 DOI: 10.1016/j.asjsur.2023.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
- Qiaoyun Min
- School of Basic Medicine, Hebei North University, Zhangjiakou, Hebei, 075000, China; Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China
| | - Yabin Shi
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China
| | - Tongtong Wang
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China; Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Huanfen Zhao
- School of Basic Medicine, Hebei North University, Zhangjiakou, Hebei, 075000, China; Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, China.
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Muacevic A, Adler JR. Primary Malignant Melanoma of the Genitourinary System: A Systemic Review and Report of Eight Cases. Cureus 2022; 14:e30444. [PMID: 36407184 PMCID: PMC9671744 DOI: 10.7759/cureus.30444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 01/25/2023] Open
Abstract
Malignant melanoma (MM) of mucosal membranes (excluding anus and head-neck) is a rare but aggressive disease with poor outcomes. The knowledge of this tumor's development, etiology, and management is scarce, mainly due to the low case numbers. We presented eight cases and performed a comprehensive literature review on mucosal MM (between 1970 and 2020). We identified 47 manuscripts on 55 patients with primary mucosal MM (limited to urothelium and vagina) and reviewed demographics, tumor specifications (morphology, stage, etc.), management, and survival. We identified 10 manuscripts discussing treatment in 1595 mucosal and non-mucosal MM and extracted the data regarding the non-surgical treatment modalities of mucosal MM patients. In 63 cases, 48 tumors primarily occurred in the urothelium (urethra: 47, bladder: 1) and 15 in the vagina. Molecular studies in a subset of cases revealed alterations in c-KIT, NRAS, BRAF (non-V600E and V600E), TP53, and NF1. Fifty-three patients underwent surgery (with additional chemotherapy, immunotherapy, and radiotherapy in 19, eight, and eight patients, respectively). The outcome was available in 52 cases, showing 21 deaths, 10 without recurrence, two alive with disease, and five lost to follow-up. Shared genetic signatures in mucosal and skin MM suggest a similar development mechanism; however, unlike skin MM, there are less BRAF mutations and more PI3K/AKT/mTOR pathway alterations in mucosal MM. Prolonged chemotherapy (i.e., methotrexate) and immune-modulating agents (i.e., natalizumab) may be risk factors. The stage at diagnosis and proper surgical extirpation are keys to the prognosis and survival of patients.
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Li YH, Zhou Y, Zhang GJ, Wang YW, Wang JG, Wang XH, Li YF. Successful treatment of metastatic vulvar malignant melanoma with toripalimab: A rare case report and review of the literature. Medicine (Baltimore) 2022; 101:e30239. [PMID: 36086787 PMCID: PMC10980482 DOI: 10.1097/md.0000000000030239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Vulvar melanoma is a rare and aggressive tumor with a high risk of local recurrence and distant metastasis. The prognosis is poor with a 5-year overall survival rate of only 46.6%. Management of vulvar melanoma remains a clinical challenge. Recent evidences have shown that immune checkpoint inhibitors are effective in the treatment of vulvar melanoma. PATIENT CONCERNS AND DIAGNOSES A 63-year-old woman with vulvar malignant melanoma suffered inguinal lymph node metastasis after vulvectomy and chemotherapy. She underwent inguinal lymph node dissection and inguinal radiotherapy. The tumor progressed again and she received immunotherapy. INTERVENTIONS The tumor progressed again, and she was admitted to our hospital and received toripalimab combined with apatinib and abraxane. OUTCOMES After 6 cycles of immunotherapy, the efficacy achieved partial remission. And with toripalimab as maintenance therapy, the patient achieved durable antitumor efficacy and good safety. LESSONS In this rare case, the patient with metastatic vulvar malignant melanoma had durable antitumor efficacy and good safety when receiving toripalimab.
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Affiliation(s)
- Yi-Hui Li
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Yang Zhou
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
- The Cancer Institute, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Guang-Ju Zhang
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Yu-Wei Wang
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Jian-Gong Wang
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Xiao-Hong Wang
- Department of Chemoradiotherapy, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Yu-Feng Li
- The Cancer Institute, Tangshan People’s Hospital, Tangshan, Hebei Province, China
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