title: Extensive necrosis of visceral melanoma metastases after immunotherapy.
abstract: BACKGROUND
  The prognosis for metastatic melanoma remains poor even with traditional decarbazine or interferon therapy. 5-year survival is markedly higher amongst patients undergoing metastatectomy. Unfortunately not all are suitable for metastatectomy. Alternative agents for systemic therapy have, to date, offered no greater rates of survival beyond traditional therapy. A toll-like receptor 9 agonist, PF-3512676 (formerly known as CPG 7909) is currently being evaluated for its potential.
  
  
  METHODS
  We present the case of a 54-year-old Caucasian male with completely resected metastatic cutaneous melanoma after immunotherapy. The patient initially progressed during adjuvant high-dose interferon, with metastases to the liver, spleen, and pelvic lymph nodes. During an 18-month treatment period with PF-3512676 (formerly known as CPG 7909), a synthetic cytosine-phosphorothioate-guanine rich oligodeoxynucleotide, slow radiologic disease progression was demonstrated at the original disease sites. Subsequent excision of splenic and pelvic nodal metastases was performed, followed by resection of the liver metastases. Histologic examination of both hepatic and splenic melanoma metastases showed extensive necrosis. Subsequent disease-free status was demonstrated by serial positron emission tomography (PET).
  
  
  CONCLUSIONS
  Existing evidence from phase I/II trials suggests systemic treatment with PF-3512676 is capable of provoking a strong tumor-specific immune response and may account for the prolonged tumor control in this instance.
authors.affiliation: The Department of Hepatobiliary Surgery, Aintree University Hospital NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7AL, UK. joelstoeter@doctors.org.uk
authors.forename: David
authors.initials: D
authors.lastname: Stoeter
authors.forename: Nicola
authors.initials: N
authors.lastname: de Liguori Carino
authors.forename: Ernest
authors.initials: E
authors.lastname: Marshall
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Andrew
authors.initials: A
authors.lastname: Wu
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009336:Necrosis; D009838:Oligodeoxyribonucleotides / Q000627:therapeutic use*; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology*; D013160:Splenic Neoplasms / Q000556:secondary / Q000601:surgery; D051193:Toll-Like Receptors / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D009838:Oligodeoxyribonucleotides; C483020:ProMune; D051193:Toll-Like Receptors