A case of primary malignant melanoma of the lung responded to anti-PD-1 antibody therapy

Hirai, Ikuko; Tanese, Keiji; Obata, Shoko; Funakoshi, Takeru

doi:10.1007/s12055-017-0488-z

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Previously, 73 cases of primary malignant melanoma of the lung have been reported in the English literature. However, mutation status was only analyzed in 9 cases (Table 2) [3,[9][10][11][12][13][14][15]. Of these 9 cases, all 9 were analyzed for BRAF mutations, but only 3 cases were analyzed for NRAS and KIT mutations, and only 2 cases were analyzed for TP53 mutations.…”

Section: Discussionmentioning

confidence: 99%

An NRAS mutation in primary malignant melanoma of the lung: a case report

et al. 2020

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Background Primary malignant melanoma of the lung (PML) is extremely rare. No precursor lesions of PML have been identified, and little is known about the genetic mutations associated with the disease. Typically, 15–20% of malignant melanomas possess NRAS gene mutations, but no cases of NRAS-mutated PML have been reported in the English literature. We present a case of PML involving an NRAS mutation. Case presentation Clinical summary A 74-year-old Japanese female presented with worsening dyspnea and was admitted to hospital. Computed tomography (CT) revealed a right lung (S10) mass and pleural dissemination. Cytology of the pleural effusion in the right lung was performed, and malignant melanoma or clear cell sarcoma was suspected. A dermatological examination and gallium scintigraphy were conducted to determine the primary tumor site, but no suspicious lesions, expect for the right lung mass, were found. After admission, CT showed complicating bilateral pneumonia, and an antibiotic drug was administered, but the pleural effusion got worse. About 2 weeks later, the patient died of respiratory failure and cardiac arrest. An autopsy was performed to determine the histological diagnosis. Autopsy findings A 26x15x20-mm black and pale yellow mass was found in the right lower lobe. Many disseminated nodules were found in the right lobe. The tumor had invaded the right diaphragm. Subcarinal lymph node metastasis was also detected. Immunohistochemically, the tumor cells exhibited positivity for S-100 and HMB45 staining. The patient was diagnosed with malignant melanoma. Sanger sequencing of the tumor detected an NRAS mutation. Conclusions We found an NRAS D54N mutation in PML, which has not been reported previously anywhere in the world. Previous reports indicated that most cases of PML can be classified into the triple-wild-type, but BRAF mutation status was only analyzed in a few cases. We should analyze the mutation patterns of PML to determine whether any subtypes other than the triple-wild-type exist. PML might be a form of de novo cancer.

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Section: Discussionmentioning

confidence: 99%

An NRAS mutation in primary malignant melanoma of the lung: a case report

et al. 2020

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“…Inhibition of the PD-1 pathway by nivolumab improves OS compared with dacarbazine in advanced melanoma ( 5 ). Primary anorectal ( 11 ) and lung ( 12 ) malignant melanomas successfully treated with nivolumab were reported; however, to the best of our knowledge, this is the first case report regarding the administration of anti-PD-1 antibody followed by definitive hypofractionated RT for recurrent PMME. We administered dacarbazine as first-line therapy; however, we considered that dacarbazine therapy was not effective, and we started nivolumab as a second-line therapy.…”

Section: Discussionmentioning

confidence: 93%

Multidisciplinary therapy for metastatic primary malignant melanoma of the esophagus: A case report

et al. 2018

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Standard treatment strategies have not yet been established for primary malignant melanoma of the esophagus (PMME), and far much less for recurrent disease. There are no reports of anti-programmed death-1 antibody treatment of recurrent PMME. A 60-year-old Japanese man was diagnosed with a primary malignant melanoma in the lower esophagus. The patient underwent mediastinoscope-assisted subtotal esophagectomy, and two nodal involvements were detected in the lymph nodes (LN)s along the left gastric artery. Paclitaxel and oral fluoropyrimidine were administered for 2 months as adjuvant treatment based on results of a histoculture drug response assay. Computed tomography at 8 months after following surgery revealed LN metastasis around the celiac axis. The serum level of the tumor marker 5-S-cysteinyldopa was elevated aberrantly. Although treatment with dacarbazine and interferon-β was initiated, metastatic disease progressed. Therefore, we started anti-programmed death-1 antibody therapy. Following 8 treatment courses, the patient demonstrated a partial response; however, after following 4 more treatment courses, the patient demonstrated progressive disease. Next, hypofractionated radiotherapy was targeted at the metastatic LN and resulted in a partial response. Then, ipilimumab, an anti-cytotoxic T-lymphocyte associated antigen 4, was administered at a dose of 3 mg/kg. After the initial administration of ipilimumab, grade 3 peripheral neuropathy was recognized; thereafter, ipilimumab was not administered. A total of 18 months after following treatment for metastatic LNs, the LN decreased in size, and there were no other signs of metastasis to other organs. The patient then underwent laparoscopic celiac axis lymphadenectomy. Pathological examination of the surgical specimens identified no viable melanoma cells. A total of 8 months after following surgery, he is free from evidence of disease recurrence. This is the first reported case of recurrent PMME successfully treated with multidisciplinary therapy including anti-programmed death-1 antibody therapy, radiotherapy and laparoscopic lymphadenectomy.

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