Case Report: Stereotactic body radiation treatment for immunotherapy escaped oligometastatic progression in cutaneous melanoma and merkel cell carcinoma

Frontiers in Oncology

Oncology

Alice Zhou¹  Omar Butt¹  George Ansstas¹  Jiayi Huang²  Karam Khaddour³ 

[1] Department of Medicine, Division of Medical Oncology, Washington University in Saint Louis- Division of Medical Oncology, Saint Louis, MO, United States;Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, United States;Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, United States;

关键词: melanoma;    merkel cell carcinoma;    oligometastatic progression;    stereotactic body radiation therapy;    immunotherapy;    CtDNA;   

DOI  :  10.3389/fonc.2023.1276729

 received in 2023-08-12, accepted in 2023-09-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

Oligometastatic progression represents a unique manifestation of tumor immune-escape that can lead to disease progression during treatment with immune checkpoint inhibitor (ICI). The diagnosis and further optimal management of oligometastatic progression through ICI remains unclear. Diagnostic challenges include practical limitations due to the anatomical sites of oligometastatic progression, such as the para-aortic region, where traditional tissue biopsy carries high risk, and circulating-tumor DNA (ctDNA) could aid in diagnosis and disease monitoring as a supplement to surveillance imaging. In this report, we describe two cases of one patient with metastatic melanoma and the other with metastatic Merkel cell carcinoma (MCC) who were treated with ICI and later developed localized resistance due to oligometastatic progression. We further highlight our experience using stereotactic body radiation therapy (SBRT) as a salvage approach to treat the oligometastatic progression. In addition, we describe the temporal and dynamic relationship of circulating-tumor DNA (ctDNA) prior to, during and after SBRT, which highly suggested the diagnosis without obtaining a histological specimen. Our cases highlight a potential role for SBRT in the management of oligometastatic progression. However, large prospective trials are essential to confirm the utility of this approach.

【 授权许可】

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Copyright © 2023 Khaddour, Zhou, Butt, Huang and Ansstas