RT Journal Article
SR Electronic
T1 Response to combined peptide receptor radionuclide therapy and checkpoint immunotherapy with ipilimumab plus nivolumab in metastatic Merkel cell carcinoma
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.121.262344
DO 10.2967/jnumed.121.262344
A1 Justin Ferdinandus
A1 Wolfgang Peter Fendler
A1 Katharina Lueckerath
A1 Christoph Berliner
A1 Sabine Kurzidem
A1 Eva Hadaschik
A1 Joachim Klode
A1 Lisa Zimmer
A1 Elisabeth Livingstone
A1 Dirk Schadendorf
A1 Ken Herrmann
A1 Juergen Christian Becker
A1 Selma Ugurel
YR 2021
UL http://jnm.snmjournals.org/content/early/2021/09/02/jnumed.121.262344.abstract
AB Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine cancer of the skin. For patients who are refractory to immune checkpoint inhibition (ICI), treatment options are limited. Few cases of MCCs with high somatostatin receptor (SSTR) expression were reported to show responses upon SSTR-directed peptide receptor radionuclide therapy (PRRT). A combination of PRRT and ICI has not been reported in MCC to date. A 60-year old man with metastatic MCC, who was primarily resistant to the anti-PD-L1 ICI with avelumab and secondarily resistant to the anti-CTLA4 plus anti-PD-1 ICI therapy with ipilimumab plus nivolumab (IPI/NIVO) with additional RT, presented with multiple bone and lymph node metastases. After confirmation of SSTR expression, the patient was treated with a salvage therapy of additional four doses of IPI/NIVO combined with two cycles of PRRT. Treatment was well tolerated with transient hematoxicity and mild nausea. Re-staging three months after therapy start showed an exceptional good response. This case report demonstrates the feasibility of a combined treatment with IPI/NIVO and PRRT as a salvage option for MCC patients progressing under ICI therapy. Prospective evidence confirming the additive value of combining ICI and radionuclide therapy in a larger cohort is needed.