Key result
Treatment with ipilimumab and nivolumab led to significant reduction in cardiac metastasis and symptom relief in a 65-year-old man, though complicated by severe colitis.
Why the study?
Data on patients treated with immunotherapy for melanoma with cardiac involvement are scarce, despite immunotherapy being recommended as first-line treatment.
Case Report (n=1)
Immunotherapy with ipilimumab and nivolumab can effectively reduce cardiac melanoma metastases and alleviate symptoms, though immune-related adverse events like colitis remain a significant risk.
May alleviate cardiac metastasis symptoms; hypothesis-generating and should not yet change practice.
BACKGROUND: Cardiac metastasis of melanoma rarely causes heart failure symptoms and the recognition of cardiac involvement is in most cases first established post-mortem. Surgical removal might be considered in selected cases in patients with an inflow or outflow tract obstruction even though the survival remains poor. Frequently, the metastasis cannot be removed and therapeutic options include conventional chemotherapy or immunotherapy, which is currently recommended as first-line treatment. Since the introduction of immunotherapy survival in metastatic disease has significantly increased but data on patients treated for melanoma with cardiac involvement are scarce. CASE SUMMARY: A 65-year-old man presented with dyspnoea and fatigue. Computed tomography scan revealed tumour processes in the heart, which was confirmed on echocardiography. Biopsies taken from fluorodeoxyglucose positron emission tomography positive lymph nodes in the axilla and groin showed melanoma. Analyses did not reveal BRAF mutation and the PD-L1 expression in tumour cells was below 1%. Treatment with ipilimumab and nivolumab was initiated and cardiopulmonary symptoms subsided during the following months with significant reduction in cardiac metastasis on echocardiography. Unfortunately, the patient developed immune checkpoint inhibitor-induced colitis and could no longer continue on the therapy. Due to development of extra-cardiac and cerebral metastasis, he was referred to palliative care. DISCUSSION: This case demonstrates that timely treatment with immunotherapy could be a safe and effective option for melanoma with cardiac involvement. During treatment, the patient developed severe colitis, a known side effect to immunotherapy. Though this often can be managed with steroids it complicates further treatment.
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Poulsen et al. (2019) conducted a case report in Metastasis of melanoma to the heart (n=1). Ipilimumab and nivolumab was evaluated on Cardiopulmonary symptoms and cardiac metastasis size on echocardiography. Treatment with ipilimumab and nivolumab led to significant reduction in cardiac metastasis and symptom relief in a 65-year-old man, though complicated by severe colitis.
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