Vaginal Mucosal Melanoma: a Complete Remission after Immunotherapy and '0-7-21' Radiotherapy Regimen (24 Gy/3 fractions/21 days)

Abstract

We present the case of a patient with vaginal mucosal melanoma who underwent complete remission after immunotherapy and ‘0-7-21’ radiotherapy regimen (24 Gy/3 fractions/21 days). An 80-year-old woman had a biopsy of a voluminous vaginal lesion and received a histological diagnosis of melanoma with angiomatoid aspects. The patient underwent immunotherapy with pembrolizumab 2 mg/kg every 3 weeks and was sent to our attention for planning radiotherapy as the extent of the lesion did not make it susceptible to surgery. Considering the concomitant administration of pembrolizumab, we chose to treat this patient with a modulated intensity radiation therapy technique delivering a hypofractionated dose of 24 Gy in 3 fractions delivered on days 0, 7, and 21. We observed a complete clinical remission of the melanoma 12 months after radiotherapy and she has been alive for 18 months with no clinical signs of local recurrence.

Multicenter Evaluation of Radiation and Immune Checkpoint Inhibitor Therapy in Mucosal Melanoma and Review of Recent Literature

“…While long-term survival remains low, local control of 74% at 2 years was achieved with postoperative or definitive RT, which is in line with prior studies. 2 , 18 , 20 , 21 Case reports of RT and ICI for vaginal 22 , 23 , 24 , 25 and anorectal 26 , 27 melanoma have also demonstrated durable responses. We found that favorable local control was possible even in patients with node-positive disease, with 2-year overall survival 100% and local control 100%.…”

Pembrolizumab in Vaginal Carcinoma: A Case Report and Review of the Literature

“…Pembrolizumab also showed efficacy in a patient with vulva verrucous carcinoma in neoadjuvant setting in association with chemotherapy [14]. Pembrolizumab also demonstrated good disease control in rare histologies, such as metastatic vaginal adenocarcinoma, clear cell carcinoma of the vulva, and vulvo-vaginal mucosal melanoma [15‒18].…”

Near complete remission of a locally advanced giant melanoma of the vulva following hypo‑fractionated radiotherapy and immune checkpoint inhibitors: A case report

“…There are few reports concerning this combination therapy for vaginal melanoma. Parisi et al (31) reported that a patient with vaginal melanoma achieved CR after HFRT combined with ICIs. Schonewolf et al (32) presented two cases of vaginal melanoma, where both patients achieved CR.…”