Recently, newer
therapies such as
immunotherapy have been increasingly used in the treatment of several
tumors, including advanced
melanoma. In particular, several studies showed that the combination of
ipilimumab, an anti-Cytotoxic T-lymphocyte Associated
Protein 4 (CTLA-4)
monoclonal antibody and
nivolumab, an anti-Programmed Death 1 (PD-1)
monoclonal antibody, leads to improved survival in patients with metastatic
melanoma. Despite that, immunotherapeutic agents may not reach therapeutic concentration in the brain due to the blood-brain barrier. We report the case of a 50-year-old man with advanced
melanoma who underwent whole-body 18F-FDG-PET/CT before and
after treatment with
immunotherapy showing resistant
brain metastases confirmed by subsequent MRI of the brain. Moreover, 18F-FDG-PET/CT was able to detect an immune-related adverse event such as
enterocolitis that contributed to the worsening of patient conditions. This case shows how a whole-body methodology such as 18F-FDG-PET/CT can be useful in identifying
melanoma cancer patients unresponsive to
immunotherapy that may benefit from traditional
palliative therapy in the effort to improve their quality of life.