Immune checkpoint inhibitors prevent malignancy cells from activating mechanisms that enable the cells to evade the hosts immune system

Immune checkpoint inhibitors prevent malignancy cells from activating mechanisms that enable the cells to evade the hosts immune system. with nivolumab developed autoimmune colitis that necessitated stopping the immunotherapy; these patients subsequently were managed with systemic corticosteroids or infliximab. Conclusions and Relevance This case series statement suggests that antiCPD-1 therapy can be used to treat metastatic conjunctival melanoma. Longer follow-up is needed to determine the long-term disease-free survival. Future studies might assess the potential for immune checkpoint inhibitors to obviate the need for orbital exenteration in selected patients with locally advanced disease. Key Points Question Can programmed cell death 1 inhibitors be used to treat conjunctival melanoma with metastases? Findings In this case series study, 4 patients with metastatic conjunctival melanoma treated with nivolumab experienced a total response to treatment with no evidence of disease at 1, 7, 9, and 36 months after completing treatment. One individual treated with pembrolizumab experienced initial stable disease but progressed after 11 months of therapy. Meaning These results suggest that programmed cell death 1 inhibitors can be used to treat metastatic conjunctival melanoma. Introduction Conjunctival melanoma is usually a rare tumor with the potential to invade the eye, eyelid, and orbit and spread to regional lymphatics and distant sites, including the lungs, skin, liver, and brain. It was previously reported to have local recurrence rates of 36% to 45% at 5 years and 31% to 59% at 10 years.1 Lymph node involvement was found in 19% of patients with conjunctival melanoma and systemic metastases were found in 19% of patients within 10 years after initial diagnosis.1,2 Melanoma-related death was reported in 9% to 18% of patients at 5 years.1,2,3 The mainstay of treatment for local control PJ 34 hydrochloride is surgical excision with margins clear of tumor; locally advanced disease may necessitate an orbital exenteration. Adjuvant treatments include topical chemotherapy and radiotherapy and are PJ 34 hydrochloride aimed at improving local control. Historically, treatment options for metastatic conjunctival melanoma have been limited. In recent years, immune checkpoint inhibitors, a new class of drugs, have been successfully used to treat metastatic cutaneous melanoma. Immune checkpoint inhibitors prevent malignancy cells from activating mechanisms that enable the cells to evade the hosts immune system. Immune checkpoint inhibitors, by blocking receptors on the surface of activated T lymphocytes, such as programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4), facilitate the acknowledgement of malignancy cells by PJ 34 hydrochloride lymphocytes and a consequent effective immune response. Ipilimumab (a CTLA-4 inhibitor), pembrolizumab (a PD-1 inhibitor), and nivolumab (a PJ 34 hydrochloride PD-1 inhibitor) are approved by the US Food and Drug Administration for the treatment of metastatic cutaneous melanoma; nivolumab and ipilimumab are also approved for the treatment of unresectable cutaneous melanoma.4,5,6 Rabbit Polyclonal to CCR5 (phospho-Ser349) Large-scale studies have reported improved survival of patients with metastatic or unresectable cutaneous melanoma treated with these drugs.7,8,9 Since 2013, we have used PD-1 inhibitors for our patients with metastatic conjunctival melanoma given that no drugs are approved for this rare form of melanoma. We present PJ 34 hydrochloride our experience treating 5 patients with metastatic conjunctival melanoma with PD-1 inhibitors. Methods We performed a retrospective review of the medical records of all 5 patients with conjunctival melanoma who were treated with immune checkpoint inhibitors under the care of one of us (B.E.) from March 6, 2013, to July 7, 2017. The medical records were examined for clinical and pathologic findings, treatments, and outcomes. This study was deemed exempt by the institutional review table of the University or college of Texas MD Anderson Malignancy Center because this statement was a collection of 5 individual cases; the institutional evaluate table of the University or college of Texas MD Anderson Malignancy Center exempts such reports from full evaluate and continuing reviews, as no generalizable information is given. Information was obtained and reported in a manner that was compliant with the standards set forth by the Health Insurance Portability and.