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[18F]Fluorodeoxyglucose Positron Emission Tomography Reveals a Complete Remission of Refractory Metastatic Melanoma after Therapy with Ipilimumab
Address for correspondence: Dr. Hojjat Ahmadzadehfar, Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str., 25 Bonn, Germany. E-mail: hojjat.ahmadzadehfar@ukb.uni-bonn.de
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Abstract
Ipilimumab (YERVOY) is a monoclonal CTLA-4-antibody with anti-tumor-immunogenic effect and is used to treat malignant melanoma. In this case study, we present [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) images of a 37-year-old woman with metastatic melanoma, who was previously treated with interferon-alpha therapy and dacarbazine and still progressed. After four cycles of ipilimumab, there was a complete remission of the disease with no evidence of vital, FDG-positive tumor tissue. The follow-up for a total of 1 year confirmed the therapeutic success. This report demonstrates that FDG-PET/CT is a reliable imaging method for response monitoring in metastatic melanoma treated with ipilimumab.
Keywords
FDG-PET
metastatic
refractory
melanoma
ipilimumab
A previously healthy 37-year-old woman was diagnosed with superficial spreading melanoma (tumor thickness 14.8 mm, CL IV-V) in the left posterior shoulder (stage IIIc, pT4a pN2c cM0). After both interferon-alpha (IFNα) therapy and subsequently initiated dacarbazine (DTIC) chemotherapy, restaging indicated progressive disease with newly developed lymph node, soft tissue, and bone metastasis (stage IV, pT4a pN3 M1c). Hence, a therapy with ipilimumab was initiated. This led to a significant decrease of the tumor marker s-100 to a normal level. After four cycles of ipilimumab, vital tumor tissue could not be detected via [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), thus the imaging substantiated a complete remission of the disease. The follow-up every 4 months for a total of 1 year confirmed the therapeutic success.
Our study demonstrates a response monitoring via FDG-PET/CT before and after a therapy of ipilimumab in a patient with refractory metastatic melanoma [Figure 1].
- (a) The initial FDG-PET/CT images after interferon-α therapy showed FDG-positive tumor recurrence in the left axilla, a soft tissue metastasis lateral of the left upper arm (SUV 4.1, SUVmax 6.8), and bone filiaeindens axis (A1, SUV 3.9, SUVmax 7.1). (b) The images 1 month later were made before radiotherapy (RTx) of the bone metastasis. Fused PET/CT indicated a significant osseous metastatic spread in C2 (SUVmax 11.2), C3 (b1) and os sacrum (SUV3.5). There was increased tracer uptake in a lymph node metastasis in the cervicothoracic junction (SUVmax 11.5) dextroventral and small lymph node metastasis is dextroinfracarinal (SUVmax 7.5). (c) The images 2 months after DTIC-therapy identified new bone filiae in the right acromion (SUV 5.4, SUVmax 14.1). Still malignancy typical uptake could be observed in os sacrum (SUV 3.4, SUVmax 5.8) and in the previously described lymph nodes dextrocervicolateral as well (SUV 4.9, SUVmax 11.1). There was a suspicious uptake sinistrocervical (SUV 3.2, SUVmax 4.3). (d) The last image is FDG-PET/CT after ipilimumab-therapy (IPI). There was no evidence of vital, FDG-positive tumor tissue. Thus, in comparison to the previous study, there was a significant improvement of the known osseous (d1) and lymphatic metastatic spread.
Ipilimumab (YERVOY) is a monoclonal antibody that mobilizes the T-cell-immuneresponse and thus exerts an anti-tumor-immunogenic effect.[123] It blocks CTLA-4, which is expressed on T cells and slows down the immune response.[45] The effects of ipilimumab are induced by the excessive activity of the immune system.[1234] This substance proved to be effective in advanced melanoma and showed a significant improvement of the overall survival.[123] FDG-PET/CT is highly sensitive in detecting sites of disease; therefore, it has an established role in the managing of metastatic melanoma.[67] Sachpekidis et al.[8] show that FDG-PET/CT has a good predictive efficiency of the final treatment outcome after therapy with ipilimumab in patients with metastatic melanoma.
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Conflicts of interest
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