Risk of cumulative toxicity after complete melanoma response with pembrolizumab.
Pembrolizumab is an approved first-line systemic therapy for unresectable metastatic melanoma. Despite the achievement of complete and durable responses in a small subgroup of patients, it is standard practice that pembrolizumab therapy continues beyond complete response. Nevertheless, the incidence of immune-related toxicities gradually increases with continuing pembrolizumab therapy. We report a case highlighting the occurrence of serious induced immune-related adverse events, which were attributed to pembrolizumab in a patient with metastatic melanoma who obtained a complete response (CR) after receiving pembrolizumab for a total of 6.5 months. Although mild pembrolizumab-related toxicity persists, the patient remains disease-free 5.5 months after discontinuation of pembrolizumab. Accordingly, we believe that cessation of pembrolizumab should be considered in patients who achieve a CR because of the ongoing risk of toxicity with extended pembrolizumab administration.
Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Amy Hsin-Chieh
AH
Hsieh
Radiology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Sarah
S
Faithfull
Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Michael P
MP
Brown
D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D006119:Groin; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000139:chemically induced* / Q000188:drug therapy; D020363:Limbic Encephalitis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D010388:Pelvis; D013974:Thyroxine / Q000627:therapeutic use
D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C582435:pembrolizumab; D013974:Thyroxine; D006854:Hydrocortisone