Even though
ipilimumab is a promising antibody used for stage IV
melanoma therapy, the response varies and is difficult to predict. We here report on a case of successful treatment with
ipilimumab in
dacarbazine-resistant metastatic
malignant melanoma, including a review of the literature on the long-term treatment results. A 62-year-old patient with a history of a resected
lentigo-maligna melanoma 5 years earlier and parotideal
metastasis 1 year before was admitted with a newly detected 3.5 cm liver
metastasis. Atypical liver resection was performed (R1). Immunohistochemically, CD3+ T-lymphocytes and CD68+ macrophages were detected at the tumour margins and within the parotideal and hepatic
melanoma metastases. A sub-analysis of the liver
metastasis showed scattered FOX-P3+ regulatory T-lymphocytes as well as multiple CD8+ effector T-cells.
Chemotherapy with
dacarbazine 1,000 mg/m(2)/day was administered at 4-weeks intervals for 3 months. A follow-up positron-emission computed tomography and liver biopsy revealed
melanoma metastases in the liver, lungs, and mediastinum. Compassionate use of
ipilimumab was administered at 3 mg/kg every 3 weeks for a total of four doses. After an initial increase in tumour size, most lesions responded, but progressive axillary and cervical
lymphadenopathy was observed before complete remission was achieved. Side effects included
fatigue, dyspnoea,
cough, upper
abdominal pain with diarrhoea, and
gingival hyperplasia. Now, 36 months after
ipilimumab therapy and 8 years after the initial
melanoma diagnosis, the tumour did not recur. It would be challenging to hypothesize that long intervals between diagnosis and need for treatment, clinical side effects, an initial increase in tumour size and the presence of intra-tumoural T-cells and macrophages might predict tumour response.