Dual Immunotherapy in a Patient with Rapidly Progressive Metastatic Melanoma Without Failure of Grafted Kidney

Abstract

A 58-year-old female presented with a right axillary mass, which was confirmed as Stage IB BRAF-mutant melanoma based on the histology of the resected mass. The patient’s history included a left upper arm melanoma that was resected in 2012; an allograft renal transplant secondary to polycystic kidney disease from a deceased donor, which they had undergone in 2009; and immunosuppressive therapy, which they had been on since the transplant took place. The patient relapsed 8 months after axillary clearance. Dual immunotherapy is the first-line treatment for BRAF-mutant melanoma, but it has been associated with high rates of solid organ graft rejection in systematic reviews. For this reason, targeted therapy with dabrafenib and trametinib was commenced in the first instance, which halted disease progression for 10 months. On progression, dual immunotherapy was again discussed, and the patient fully consented regarding risks of graft loss. They had an excellent treatment response, and their renal graft remains functional.