Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5830
Peer-review started: June 18, 2023
First decision: July 4, 2023
Revised: July 5, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: August 26, 2023
Processing time: 67 Days and 10.2 Hours
Immunotherapy has revolutionized the treatment of metastatic melanoma, but a significant proportion of patients still experience treatment resistance. Fecal microbiota transplantation (FMT) has emerged as a potential strategy to overcome immunotherapy resistance by modulating the gut microbiome.
We present a case report of a 57-year-old male with metastatic melanoma refractory to immunotherapy who received FMT in combination with anti-programmed death-ligand 1 (PD-L1) immunotherapy (pembrolizumab). After failing multiple lines of treatment, the patient underwent a single FMT procedure by colonoscopy using fecal material from a female metastatic melanoma donor who successfully responded to immunotherapy. Following FMT, the patient demonstrated a response with decreased subcutaneous disease and subsequently underwent surgery to remove the residual disease. Despite a subsequent recurrence in the small bowel that was resected, the patient remained on pembrolizumab without evidence of melanoma recurrence at the time of writing.
The favorable clinical and long-lasting effect we saw in our patient without significant toxicity suggests that this procedure should be considered in similar patients with immunotherapy refractory melanomas.
Core Tip: This case report highlights the use of fecal microbiota transplantation (FMT) as a potential strategy to overcome immunotherapy resistance in metastatic melanoma patients. The case involves a 57-year-old male who had failed multiple lines of treatment and received FMT alongside anti-programmed death-ligand 1 immunotherapy. Following FMT, the patient showed a response with a decrease in disease burden and remained on immunotherapy more than two years. This suggests that FMT may restore sensitivity to immunotherapy in refractory cases. Further research is needed to understand the underlying mechanisms and optimize treatment protocols for FMT in metastatic melanoma.