title: Combined immunotherapy and radiation for treatment of mucosal melanomas of the lower genital tract.
abstract: OBJECTIVE
  To report our experience using ipilimumab, a monoclonal antibody targeting CTLA-4, combined with radiation therapy in women diagnosed with mucosal melanoma of the lower genital tract.
  
  
  METHODS
  We retrospectively identified all patients who received ipilimumab with concurrent radiation treatment of mucosal melanoma of the lower genital tract at Memorial Sloan Kettering Cancer Center from 2012 to 2015. Various clinicopathologic data and treatment response were abstracted and analyzed.
  
  
  RESULTS
  Four patients were identified. Median age was 61.5 years (range 44-68); 3 were diagnosed with vaginal melanoma, 1 with cervical melanoma. All would have required extensive surgical procedures to remove entirety of disease. Median size of lesions was 4.7 cm (range, 3.3-5.3); all were Ballantyne stage I. Median number of doses of upfront ipilimumab was 4 (range, 3-4). Two patients suffered CTCAE grade 3 adverse events (colitis, rash). All received external beam radiation: 3 to 3000 cGy, 1 to 6020 cGy. Post-radiation surgical resection was performed in 3 patients (75%); 1 (33%) of 3 patients achieved complete pathologic response. Complete local radiographic response was observed in all patients after completion of initial therapy and surgery. Two developed recurrence at 9 and 10 months post-diagnosis (mediastinum, lung); 2 remain disease-free at 20 and 38 months.
  
  
  CONCLUSIONS
  Mucosal melanoma of the lower genital tract is rare, and data-driven treatment strategies limited. Immunotherapy has demonstrated durable efficacy in the treatment of cutaneous melanomas. Our small case series shows a favorable response to combined ipilimumab and radiation therapy. Larger studies are needed to validate these promising results.
authors.affiliation: Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Schiavone
authors.affiliation: Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Vance
authors.initials: V
authors.lastname: Broach
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Shoushtari
authors.affiliation: Experimental Therapeutics, Division of Hematology/Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, USA; Melanoma Service, Division of Hematology/Oncology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Carvajal
authors.affiliation: Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Kaled
authors.initials: K
authors.lastname: Alektiar
authors.affiliation: Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Kollmeier
authors.affiliation: Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.affiliation: Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
keywords: Cervical melanoma; Gynecologic mucosal melanoma; Immunotherapy; Ipilimumab; Radiation therapy; Vaginal melanoma