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Restoring Immune Mediated Disease Control by Ipilimumab Re-exposition in a Heavily pretreated Patient With MSI-H mCRC

  • Frank Jordan
    Correspondence
    Address for correspondence: Dr. med Frank Jordan, Comprehensive Cancer Center, University Medical Center Augsburg, Medical Department, Division of Hematology and Oncology, Stenglinstr. 2, 86156 Augsburg, Germany
    Affiliations
    Comprehensive Cancer Center Augsburg, University Medical Center Augsburg, Medical Department, Division of Hematology and Oncology, Germany
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  • Martin Trepel
    Affiliations
    Comprehensive Cancer Center Augsburg, University Medical Center Augsburg, Medical Department, Division of Hematology and Oncology, Germany
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  • Rainer Claus
    Affiliations
    Comprehensive Cancer Center Augsburg, University Medical Center Augsburg, Medical Department, Division of Hematology and Oncology, Germany
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Published:January 07, 2022DOI:https://doi.org/10.1016/j.clcc.2022.01.003

      Abstract

      Background

      Immune-Checkpoint-inhibitors (ICIs) are approved in first line therapy of microsatellite-instable, deficient miss-match-repair (MSI-H-dMMR) metastatic colorectal cancer (mCRC), and in second line after standard chemotherapy. Evidence supporting immunotherapy after immunotherapy is scarce.

      Case report

      This case report highlights the course of a heavily pretreated patient with MSI-H mCRC with progression after multiple local therapies, standard chemotherapies and pembrolizumab. After 4 cycles of ipilimumab and nivolumab followed by nivolumab-maintenance he achieved a long-lasting disease control of 22 months. After further subsequent progression he regained immune mediated disease control by a second “boost” of ipilimumab.

      Conclusion

      Re-exposition with ipilimumab is a potential option to restore immune-mediated-disease-control in patients with preceding long-lasting response to ipilimumab/nivolumab and with dMMR-tumors. The clinical situation of progress after long-lasting disease control on ICIs becomes more common and is an opportunity to investigate potential strategies for restoring immune mediated disease control.

      Keywords

      List of Abbreviations:

      mCRC (metastatic colorectal cancers), ICIs (Immune-Checkpoint Inhibitors), MSI-H (microsatellite instable high), dMMR (deficient mismatch repair)
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