Selective inhibition of autoimmune exacerbation while preserving the anti-tumor clinical benefit using IL-6 blockade in a patient with advanced melanoma and Crohn's disease: a case report.
Novel immunotherapies, or checkpoint inhibitors, targeting programmed cell death protein-1 (PD-1) and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) have significantly improved outcomes for patients with numerous different cancer types. However, owing to their exclusion from clinical trials and risk for autoimmune exacerbation on these treatments, the impact on safety and degree of toxicity of these potentially life-prolonging therapies is not well characterized in patients with an underlying autoimmune disease or previous organ transplant.



We report a case of a patient with advanced melanoma and refractory Crohn's disease who was treated concurrently with pembrolizumab (anti-PD-1 antibody) and tocilizumab (anti-interluekin-6 receptor antibody). This novel treatment strategy was well tolerated and did not result in Crohn's disease exacerbation for at least 16 weeks. Importantly, this treatment resulted in marked, durable antitumor responses.



This outcome suggests that targeted immunosuppression combined with checkpoint inhibitors may hold promise as a treatment strategy for this unique patient population and may warrant additional study.
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Marc
M
Uemura
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Van A
VA
Trinh
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Cara
C
Haymaker
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Natalie
N
Jackson
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Dae Won
DW
Kim
Department of Immunology, University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
James P
JP
Allison
Department of Genitourinary Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Padmanee
P
Sharma
Department of Immunology, University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Luis
L
Vence
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Chantale
C
Bernatchez
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA.
Patrick
P
Hwu
DDepartment of Melanoma Medical Oncology, University of Texas-MD Anderson Cancer Center, 1515 Holcolmbe Blvd., Houston, TX, 77030, USA. adiab@mdanderson.org.
Adi
0000-0002-0153-0244
A
Diab
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015551:Autoimmunity / Q000187:drug effects; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008545:Melanoma / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D000093242:Interleukin-6 Inhibitors
D061067:Antibodies, Monoclonal, Humanized; D000074322:Antineoplastic Agents, Immunological; D061026:Programmed Cell Death 1 Receptor; D000093242:Interleukin-6 Inhibitors; C105992:PDCD1 protein, human; C582435:pembrolizumab; C502936:tocilizumab
CTLA-4; Checkpoint inhibitors; Crohn’s disease; Metastatic melanoma; PD-1; Pembrolizumab; Tocilizumab