Skin cancer is the most commonly diagnosed malignancy in the United States, and invasive cutaneous melanoma is responsible for the vast majority of skin cancer-related deaths. Treatment options for patients with regional nodal disease, in-transit metastases, or locally advanced or distant metastatic disease are challenging. Historically survival rates in this patient population are dismal. Improved systemic control is possible using targeted agents and checkpoint inhibitors have redefined treatment outcomes. Furthermore, multi-modal therapy incorporating radiation may improve survival outcomes by priming the immune system for antigen release and help in reversing T-cell exhaustion. Herein, we describe a patient with widespread metastatic melanoma with progressive systemic disease while receiving checkpoint inhibition therapy that was reversed after combined immunoradiotherapy. The patient is now more than 41 months from diagnosis with durable, stable systemic disease.
Keywords: abscopal effect; immunotherapy; melanoma; pd-1; radiation therapy; stereotactic ablative radiotherapy.