Published online Oct 24, 2019. doi: 10.5306/wjco.v10.i10.350
Peer-review started: February 27, 2019
First decision: April 11, 2019
Revised: July 22, 2019
Accepted: September 5, 2019
Article in press: September 5, 2019
Published online: October 24, 2019
Processing time: 240 Days and 5.5 Hours
Dual checkpoint inhibition improves response rates in treatment naïve patients with metastatic melanoma compared to monotherapy. However, it confers a higher rate of toxicity, including immune-related colitis. Steroids may not resolve symptoms in all cases. The use of vedolizumab, a humanized monoclonal antibody against α4β7 integrin has proven effective in cases refractory to standard treatment.
We report the case of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab. She developed severe colitis refractory to methylprednisolone, infliximab and mycophenolate mofetil but responded to vedolizumab.
This case report supports vedolizumab use in severe immune related colitis refractory to standard immunosuppression.
Core tip: Dual checkpoint inhibition improves response rates in treatment naïve patients with metastatic melanoma compared to monotherapy. However, it confers a higher rate of toxicity, including immune-related colitis. The use of vedolizumab, a humanized monoclonal antibody against α4β7 integrin has proven effective in cases refractory to standard treatment. This is a case report of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab. She developed severe colitis refractory to methylprednisolone, infliximab and mycophenolate mofetil but responded to vedolizumab. This supports its use in severe immune related colitis refractory to standard immunosuppression.