title: A word of caution: do not wake sleeping dogs; micrometastases of melanoma suddenly grew after progesterone treatment.
abstract: BACKGROUND
  Hormonal treatment might affect the immune response to tumor antigens induced in cancer patients who are being vaccinated.
  
  
  METHODS
  A 33-year-old woman was diagnosed with cutaneous melanoma in May 2009. Her melanoma was located in the intermammary sulcus, had a Breslow thickness of 4 mm, a Clark's level IV, it was ulcerated and highly melanotic. The bilateral sentinel node biopsy was negative. She entered into a randomized Phase II/III clinical study comparing a vaccine composed of irradiated melanoma cells plus BCG plus GM-CSF versus IFN-alpha 2b and she was assigned to the vaccine arm. During the two years treatment she remained disease-free; the final CAT scan being performed in August 2011. Between November and December 2011, her gynecologist treated her with three cycles of 200 mg progesterone/day for ten days, every two weeks, for ovary dysfunction. In November 2011 the patient returned to the Hospital for clinical and imaging evaluation and no evidence of disease was found. At the next visit in March 2012 an ultrasound revealed multiple, large metastases in the liver. A CAT scan confirmed the presence of liver, adrenal glands and spleen metastases. A needle biopsy of a liver lesion revealed metastatic melanoma of similar characteristics to the original tumor. We suggest that progesterone treatment triggered proliferation of so far dormant micrometastases that were controlled during CSF470 vaccine treatment.
  
  
  CONCLUSIONS
  The use of progesterone in patients with melanoma that are under immunological treatments should be carefully considered, since progesterone could modify the balance of pro-inflammatory and Th1 functions to a regulatory and anti-inflammatory profile of the immune system that could have an impact in tumor progression.
authors.affiliation: Instituto Alexander Fleming, Cramer 1180, Buenos Aires, Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Mordoh
authors.forename: Ivana Jaqueline
authors.initials: IJ
authors.lastname: Tapia
authors.forename: Maria Marcela
authors.initials: MM
authors.lastname: Barrio
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary*; D000328:Adult; D001932:Brain Neoplasms / Q000556:secondary*; D019496:Cancer Vaccines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008545:Melanoma / Q000556:secondary* / Q000628:therapy; D061206:Neoplasm Micrometastasis; D010048:Ovarian Cysts / Q000188:drug therapy; D011374:Progesterone / Q000009:adverse effects*; D011372:Progestins / Q000009:adverse effects*; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D013160:Splenic Neoplasms / Q000556:secondary*
chemical_list: D019496:Cancer Vaccines; D011372:Progestins; D011374:Progesterone