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        Investigating the role of immunotherapy in advanced/recurrent female genital tract melanoma: a preliminary experience

        Alice Indini,Lorenza Di Guardo,Carolina Cimminiello,Domenica Lorusso,Francesco Raspagliesi,Michele Del Vecchio 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6

        Objective: immunotherapy with immune checkpoint inhibitors has become one of thestandard therapeutic modalities for patients with advanced melanoma. Melanoma of thefemale lower genital tract is a rare and aggressive disease, with poor long-term clinicaloutcomes. To date, no study evaluated the role of immunotherapy in metastatic melanoma ofthe lower genital tract. Methods: Data of women with metastatic melanoma of the lower genital tract wereprospectively collected. Survival outcomes over time was assessed using Kaplan-Meier model. Results: Seven cases of metastatic melanoma of the lower genital tract (vulva [n=2], vagina[n=4], and uterine cervix [n=1]) treated with immune checkpoint inhibitors are reviewed. Two patients had metastatic disease at diagnosis, while 5 patients developed metastaticdisease at a mean (standard deviation) time of 9.9 (±3.0) months from primary diagnosis. Four patients received an anti-cytotoxic T lymphocyte-associated antigen 4 (CTLA4)(ipilimumab) and 3 received an anti-programmed cell death 1 (PD-1) (pembrolizumab[n=2], nivolumab [n=1]) therapy. The response rate to immunotherapy was 28.5%. Patientsreceiving an anti-PD-1 experienced a better progression-free survival than patients treatedwith anti-CTLA4 (p=0.01, log-rank test). Although not reaching statistical significance,overall survival was better in patients having an anti-PD-1 therapy in comparison to anti-CTLA4 (p=0.15, log-rank test). Conclusion: Results from our series confirm the poor prognosis of women with metastaticmelanoma of the lower genital tract, thus supporting the need of exploring newtreatment modalities. Further studies are warranted to improve knowledge on the role ofimmunotherapy in metastatic melanoma of the lower genital tract.

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