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INTERESTING IMAGE
Year : 2017  |  Volume : 32  |  Issue : 1  |  Page : 66-67  

[18F]Fluorodeoxyglucose positron emission tomography reveals a complete remission of refractory metastatic melanoma after therapy with ipilimumab


1 Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
2 Institute of Radiology and Nuclear Medicine and PET-CT Center, Bonn, Germany

Date of Web Publication17-Jan-2017

Correspondence Address:
Hojjat Ahmadzadehfar
Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str., 25 Bonn
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.198490

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   Abstract 

Ipilimumab (YERVOY) is a monoclonal CTLA-4-antibody with anti-tumor-immunogenic effect and is used to treat malignant melanoma. In this case study, we present [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) images of a 37-year-old woman with metastatic melanoma, who was previously treated with interferon-alpha therapy and dacarbazine and still progressed. After four cycles of ipilimumab, there was a complete remission of the disease with no evidence of vital, FDG-positive tumor tissue. The follow-up for a total of 1 year confirmed the therapeutic success. This report demonstrates that FDG-PET/CT is a reliable imaging method for response monitoring in metastatic melanoma treated with ipilimumab.

Keywords: FDG-PET, metastatic, refractory, melanoma, ipilimumab


How to cite this article:
Yordanova A, Schlenkhoff C, Palmedo H, Essler M, Ahmadzadehfar H. [18F]Fluorodeoxyglucose positron emission tomography reveals a complete remission of refractory metastatic melanoma after therapy with ipilimumab. Indian J Nucl Med 2017;32:66-7

How to cite this URL:
Yordanova A, Schlenkhoff C, Palmedo H, Essler M, Ahmadzadehfar H. [18F]Fluorodeoxyglucose positron emission tomography reveals a complete remission of refractory metastatic melanoma after therapy with ipilimumab. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 12];32:66-7. Available from: http://www.ijnm.in/text.asp?2017/32/1/66/198490

A previously healthy 37-year-old woman was diagnosed with superficial spreading melanoma (tumor thickness 14.8 mm, CL IV-V) in the left posterior shoulder (stage IIIc, pT4a pN2c cM0). After both interferon-alpha (IFNα) therapy and subsequently initiated dacarbazine (DTIC) chemotherapy, restaging indicated progressive disease with newly developed lymph node, soft tissue, and bone metastasis (stage IV, pT4a pN3 M1c). Hence, a therapy with ipilimumab was initiated. This led to a significant decrease of the tumor marker s-100 to a normal level. After four cycles of ipilimumab, vital tumor tissue could not be detected via [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), thus the imaging substantiated a complete remission of the disease. The follow-up every 4 months for a total of 1 year confirmed the therapeutic success. Our study demonstrates a response monitoring via FDG-PET/CT before and after a therapy of ipilimumab in a patient with refractory metastatic melanoma [Figure 1].
Figure 1: (a) The initial FDG-PET/CT images after interferon-α therapy showed FDG-positive tumor recurrence in the left axilla, a soft tissue metastasis lateral of the left upper arm (SUV 4.1, SUVmax 6.8), and bone filiaeindens axis (A1, SUV 3.9, SUVmax 7.1). (b) The images 1 month later were made before radiotherapy (RTx) of the bone metastasis. Fused PET/CT indicated a significant osseous metastatic spread in C2 (SUVmax 11.2), C3 (b1) and os sacrum (SUV3.5). There was increased tracer uptake in a lymph node metastasis in the cervicothoracic junction (SUVmax 11.5) dextroventral and small lymph node metastasis is dextroinfracarinal (SUVmax 7.5). (c) The images 2 months after DTIC-therapy identified new bone filiae in the right acromion (SUV 5.4, SUVmax 14.1). Still malignancy typical uptake could be observed in os sacrum (SUV 3.4, SUVmax 5.8) and in the previously described lymph nodes dextrocervicolateral as well (SUV 4.9, SUVmax 11.1). There was a suspicious uptake sinistrocervical (SUV 3.2, SUVmax 4.3). (d) The last image is FDG-PET/CT after ipilimumab-therapy (IPI). There was no evidence of vital, FDG-positive tumor tissue. Thus, in comparison to the previous study, there was a significant improvement of the known osseous (d1) and lymphatic metastatic spread.

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Ipilimumab (YERVOY) is a monoclonal antibody that mobilizes the T-cell-immune response and thus exerts an anti-tumor-immunogenic effect.[1],[2],[3] It blocks CTLA-4, which is expressed on T cells and slows down the immune response.[4],[5] The effects of ipilimumab are induced by the excessive activity of the immune system.[1],[2],[3],[4] This substance proved to be effective in advanced melanoma and showed a significant improvement of the overall survival.[1],[2],[3] FDG-PET/CT is highly sensitive in detecting sites of disease; therefore, it has an established role in the managing of metastatic melanoma.[6],[7] Sachpekidis et al.[8] show that FDG-PET/CT has a good predictive efficiency of the final treatment outcome after therapy with ipilimumab in patients with metastatic melanoma. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

 
   References Top

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Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 2010;363:711-23.  Back to cited text no. 1
    
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Wolchok JD, Neyns B, Linette G, Negrier S, Lutzky J, Thomas L, et al. Ipilimumab monotherapy in patients with pretreated advanced melanoma: A randomised, double-blind, multicentre, phase 2, dose-ranging study. Lancet Oncol 2010;11:155-64.  Back to cited text no. 2
    
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Weber JS, O'Day S, Urba W, Powderly J, Nichol G, Yellin M, et al. Phase I/II study of ipilimumab for patients with metastatic melanoma. J Clin Oncol 2008;26:5950-6.  Back to cited text no. 3
    
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O'Day SJ, Hamid O, Urba WJ. Targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4): A novel strategy for the treatment of melanoma and other malignancies. Cancer 2007;110:2614-27.  Back to cited text no. 4
    
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Leach DR, Krummel MF, Allison JP. Enhancement of antitumour immunity by CTLA-4 blockade. Science 1996;271:1734-6.  Back to cited text no. 5
    
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Gulec SA, Faries MB, Lee CC, Kirgan D, Glass C, Morton DL, et al. The role of fluorine-18 deoxyglucose positron emission tomography in the management of patients with metastatic melanoma: Impact on surgical decision making. Clin Nucl Med 2003;28:961-5.  Back to cited text no. 6
    
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Boellaard R, O'Doherty M, Weber W, Mottaghy F, Lonsdale M, Stroobants S, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 10. Eur J Nucl Med Mol Imaging 2010;37:181-200.  Back to cited text no. 7
    
8.
Sachpekidis C, Larribere L, Pan L, Haberkorn U, Dimitrakopoulou-Strauss A, Hassel JC. Predictive value of early (18)F-FDG PET/CT studies for treatment response evaluation to ipilimumab in metastatic melanoma: Preliminary results of an ongoing study. Eur J Nucl Med Mol Imaging 2015;42:386.  Back to cited text no. 8
    


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