A Case of Metastatic Melanoma Refractory to Immunotherapy: Is Cytotoxic Chemotherapy Still an Effective Option?

TL;DR

A patient with advanced melanoma who did not respond to immunotherapy showed a strong response to traditional chemotherapy, suggesting it can still be effective in some cases.

Contribution

Demonstrates that cytotoxic chemotherapy can be effective in metastatic melanoma patients refractory to immunotherapy.

Findings

A 63-year-old patient with BRAF wild type mucosal melanoma progressed on immunotherapy.

The patient achieved a durable response to cisplatin and dacarbazine chemotherapy.

Chemotherapy remains a viable option for some patients unresponsive to newer treatments.

Abstract

Metastatic melanoma is traditionally associated with poor responses to conventional cytotoxic chemotherapy. Although there has been a shift in paradigm in melanoma treatment in the last few decades with the use of targeted treatment and immunotherapy, there is a significant subset of patients who are treatment refractory. Interestingly, some of these patients may derive meaningful benefit from cytotoxic chemotherapy. We present the report of a case of a 63-year-old lady with BRAF wild type, locally advanced mucosal melanoma who demonstrated disease progression on combination immunotherapy with Ipilimumab and nivolumab. She subsequently achieved an exceptional and durable radiological and clinical response to chemotherapy with cisplatin and dacarbazine. This case highlights that, despite advances in personalized medicine and immunotherapy, conventional chemotherapy may still represent a valuable therapeutic option in selected patients, particularly in the refractory setting.

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