{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T01:32:13Z","timestamp":1767922333563,"version":"3.49.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T00:00:00Z","timestamp":1638921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) and radiotherapy (RT) combinations for various metastatic cancers are increasingly utilized, yet the augmentation of anti-cancer immunity including distant tumor responses by RT remains ill-characterized. Immunosuppressive tumor microenvironments and defective anti-tumor immune activation including immune-related adverse events (irAEs) likely limit dramatic immuno-radiotherapy combinations, though it remains unclear which immune characteristics mediate dramatic systemic tumor regression in only a small subset of patients. Moreover, the efficacy of ICI treatment in patients receiving immunosuppressive therapies for autoimmune conditions or irAEs is convoluted, yet clinically valuable. Here, we report a case of a 75-year-old man with myasthenia gravis and metastatic melanoma who experienced complete and durable systemic regression after receiving pembrolizumab and single-lesion RT while on prednisone for myasthenia gravis prophylaxis and vedolizumab for immune-mediated colitis after previously experiencing mixed response on pembrolizumab monotherapy. We discuss the potential paradoxical effects and clinical considerations of immunosuppressive regimens in patients with underlying autoimmune disease or adverse immune reactions while receiving immuno-radiotherapy combinations.<\/jats:p>","DOI":"10.3389\/fimmu.2021.788499","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T04:34:52Z","timestamp":1638938092000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Durable Metastatic Melanoma Remission Following Pembrolizumab and Radiotherapy: A Case Report of Prophylactic Immunosuppression in a Patient with Myasthenia Gravis and Immune-Mediated Colitis"],"prefix":"10.3389","volume":"12","author":[{"given":"Luke A.","family":"Moradi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis A.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig S.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alok S.","family":"Deshane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael C.","family":"Dobelbower","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30642","article-title":"Immune Checkpoint Inhibitors in Challenging Populations","volume":"123","author":"Johnson","year":"2017","journal-title":"Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112824","article-title":"Immunologic Correlates of the Abscopal Effect in a Patient With Melanoma","volume":"366","author":"Postow","year":"2012","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz011","article-title":"Five-Year Survival Outcomes for Patients With Advanced Melanoma Treated With Pembrolizumab in KEYNOTE-001","volume":"30","author":"Hamid","year":"2019","journal-title":"Ann Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/nrc.2018.6","article-title":"Using Immunotherapy to Boost the Abscopal Effect","volume":"18","author":"Ngwa","year":"2018","journal-title":"Nat Rev Cancer"},{"key":"B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ijrobp.2019.12.033","article-title":"Cytoreduction and the Optimization Of Immune Checkpoint Inhibition With Radiation Therapy","volume":"108","author":"Gutiontov","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-20-1790","article-title":"Improved Survival Associated With Local Tumor Response Following Multisite Radiotherapy and Pembrolizumab: Secondary Analysis of a Phase I Trial","volume":"26","author":"Luke","year":"2020","journal-title":"Clin Cancer Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30157-3","article-title":"Integration of Radiotherapy and Immunotherapy for Treatment of Oligometastases","volume":"20","author":"Pitroda","year":"2019","journal-title":"Lancet Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40425-018-0484-x","article-title":"Complete Response of Metastatic Melanoma in a Patient With Crohn\u2019s Disease Simultaneously Receiving Anti-Alpha4beta7 and Anti-PD1 Antibodies","volume":"7","author":"Frohne","year":"2019","journal-title":"J Immunother Cancer"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-26-305-234","article-title":"Whole Body Irradiation; Radiobiology or Medicine","volume":"26","author":"Mole","year":"1953","journal-title":"Br J Radiol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31186","article-title":"Could Autoimmune Disease Contribute to the Abscopal Effect in Metastatic Hepatocellular Carcinoma","volume":"72","author":"Beyls","year":"2020","journal-title":"Hepatology"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.788499\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T04:34:53Z","timestamp":1638938093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.788499\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,8]]},"references-count":10,"alternative-id":["10.3389\/fimmu.2021.788499"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2021.788499","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,8]]},"article-number":"788499"}}