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.
Subject(s)
Ipilimumab , Melanoma , Neoplasm Recurrence, Local , Nivolumab , Vaginal Neoplasms , Humans , Female , Nivolumab/therapeutic use , Nivolumab/administration & dosage , Nivolumab/adverse effects , Middle Aged , Ipilimumab/administration & dosage , Ipilimumab/therapeutic use , Ipilimumab/adverse effects , Melanoma/drug therapy , Melanoma/pathology , Vaginal Neoplasms/drug therapy , Vaginal Neoplasms/pathology , Neoplasm Recurrence, Local/drug therapy , Immune Checkpoint Inhibitors/therapeutic use , Immune Checkpoint Inhibitors/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effectsABSTRACT
BACKGROUND Primary vaginal malignant melanoma is a rare and aggressive tumor with a high risk of local recurrence and distant metastasis. Although there are several available treatment options, none are considered as standard. Surgical resection is the first treatment choice because of its superior survival benefits. CASE REPORT The patient was a 56-year-old woman with a vaginal mass. At the first visit to our institution, a 20×20 mm black and flat lesion on the lower third of the posterior vaginal wall and a polypoid mass near the vaginal fornix were detected by gynecologic examination. Study of the tumor on the posterior vaginal wall suggested that it did not extend to the uterine cervix. The preoperative diagnosis was vaginal malignant melanoma FIGO stage I (cT1, cN0, cM0). The patient underwent a total vaginectomy, pelvic and inguinal lymphadenectomy, modified radical hysterectomy, and bilateral salpingo-oophorectomy. The tumor cells were arranged in sheets and nests and exhibited nuclear pleomorphism, eosinophilic cytoplasm, brisk mitotic activity, and melanin production. The overlying mucosa was ulcerated. The tumor thickness was 2.5 mm and no residual lesion was found at the surgical margin. No adjuvant therapies were performed. The patient is alive without recurrence 15 months after the initial treatment. CONCLUSIONS This is a case of vaginal malignant melanoma for which complete response was achieved by radical tumor resection, without severe adverse effects and with no observed recurrence 15 months after the surgery.
