Nivolumab Treatment in a Mucosal Melanoma Patient with Pre-Existing
Systemic
Lupus
Erythematosus: A Case Report with Literature Review
Aleksandar Popović1,
Ivan Petković1,3, Andrija Rančić2, Aleksandra
Dimitrijević1,
Vesna Brzački2,4, Stefan Stankov5, Andrija Jović6,
Sonja Stojanović4,7
1University
Clinical Center Niš, Clinic of Oncology, Niš, Serbia
2University
Clinical Center Niš, Gastroenterology and Hepatology Clinic,
Serbia
3University
of Niš, Faculty of Medicine, Department of Oncology, Niš, Niš, Serbia
4University
of Nis, Faculty of Medicine, Department of Internal medicine Nis, Niš,
Serbia
5University
Clinical Center Niš, Clinic of Radiology, Niš, Serbia
6University
Clinical Center Niš, Clinic of Dermatovenerology, Niš, Serbia
7Institut
for Treatment and Rehabilitation “Niška Banja “, Niš, Serbia
SUMMARY
Introduction. Systemic lupus erythematosus (SLE) represents a
multisystemic disease characterized by antibody production,
complement activation, and immune complexes deposition. Certain
types of malignancies occur more often, and conversely, some of
them occur less often in SLE patients. Mucosal melanoma of the
anorectal region represents a rare form of melanoma occurring in
1.5% of all melanoma patients, predominantly female. The
introduction of novel agents dramatically changed the outcome in
melanoma patients and introduced different adverse events,
diverse contraindications, and drug interactions.
Immune checkpoint inhibitors have a role in the maintenance of
immunologic homeostasis. Patients with underlying autoimmune
diseases were often excluded from clinical trials, for fear of
possible autoimmune disease exacerbation or high-grade
immune-related adverse events. Due to that, data regarding this
subgroup of patients is limited, with no clear recommendations.
Given the fact that prevalence among the general
population is high (5 - 10%), autoimmune diseases represent
common comorbidity in cancer patients. Having that in mind, it
is of utmost importance to personalize the approach and
individualize the SLE treatment and enable the use of PD-1
antibody in the safest and most useful way while keeping the SLE
in control.
Case report. Herein we present a 79-year-old with primary
mucosal melanoma of the anorectal region, with lung metastasis
and preexisting SLE in remission. Hydroxychloroquine was the
only treatment for SLE. Nivolumab treatment was initiated in the
standard dosing schedule. After the first and second follow-up,
no further progression of melanoma was detected, with no SLE
exacerbation and immune-related adverse events.
Conclusion. PD-1 treatment in a patient with an underlying
autoimmune disease represents a viable choice with a necessity
for a multidisciplinary approach and close monitoring.
Keywords: mucosal melanoma,
systemic lupus erythematosus, immune checkpoint inhibitors,
nivolumab
Corresponding author:
Aleksandar Popović
e-mail:
popovic992@yahoo.com
ACTA FAC MED NAISS 2023;40(4):505-511