Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma
Abstract We present a case of extensive and bulky pediatric metastatic melanoma originating in the head and neck which markedly responded to combination therapy with anti-programmed cell death (PD-1) inhibition and consolidative personalized ultra-fractionated stereotactic adaptive radiotherapy (PUL...
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| Format: | Article |
| Language: | English |
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BMC
2025-08-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-025-02691-y |
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| author | Kyra L. McCarty Tanya Watt Tu D. Dan Robert D. Timmerman Kiran A. Kumar |
| author_facet | Kyra L. McCarty Tanya Watt Tu D. Dan Robert D. Timmerman Kiran A. Kumar |
| author_sort | Kyra L. McCarty |
| collection | DOAJ |
| description | Abstract We present a case of extensive and bulky pediatric metastatic melanoma originating in the head and neck which markedly responded to combination therapy with anti-programmed cell death (PD-1) inhibition and consolidative personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR). After surgical debulking with neck dissection, the patient was initially treated with anti-PD-1 and anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) dual checkpoint blockade immunotherapy, but quickly had disease progression. He was transitioned to a different anti-PD-1 immunotherapy in combination with tyrosine kinase inhibitors in conjunction with consolidative local therapy using PULSAR. This combination therapy achieved tumor response and progression-free status for one year before further disease progression at a separate site in the mediastinum. Due to otherwise good disease control, single agent anti-PD-1 immunotherapy was continued and salvage PULSAR was administered to the progressive site, again resulting in tumor response and progression-free status for 6 months. None of the bulkier sites of gross disease had local progression after combination therapy. This case suggests that the synergistic effect of PULSAR and anti-PD-1 immunotherapy is efficacious for relapsed or refractory metastatic melanoma in pediatric patients. Clinical trial number: not applicable. |
| format | Article |
| id | doaj-art-392e51dd46c94d2e96be2e528d563662 |
| institution | Kabale University |
| issn | 1748-717X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj-art-392e51dd46c94d2e96be2e528d5636622025-08-24T11:42:09ZengBMCRadiation Oncology1748-717X2025-08-012011710.1186/s13014-025-02691-yUse of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanomaKyra L. McCarty0Tanya Watt1Tu D. Dan2Robert D. Timmerman3Kiran A. Kumar4Division of Pediatric Hematology and Oncology, UT Southwestern Medical CenterDivision of Pediatric Hematology and Oncology, UT Southwestern Medical CenterDepartment of Radiation Oncology, UT Southwestern Medical CenterDepartment of Radiation Oncology, UT Southwestern Medical CenterDepartment of Radiation Oncology, UT Southwestern Medical CenterAbstract We present a case of extensive and bulky pediatric metastatic melanoma originating in the head and neck which markedly responded to combination therapy with anti-programmed cell death (PD-1) inhibition and consolidative personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR). After surgical debulking with neck dissection, the patient was initially treated with anti-PD-1 and anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) dual checkpoint blockade immunotherapy, but quickly had disease progression. He was transitioned to a different anti-PD-1 immunotherapy in combination with tyrosine kinase inhibitors in conjunction with consolidative local therapy using PULSAR. This combination therapy achieved tumor response and progression-free status for one year before further disease progression at a separate site in the mediastinum. Due to otherwise good disease control, single agent anti-PD-1 immunotherapy was continued and salvage PULSAR was administered to the progressive site, again resulting in tumor response and progression-free status for 6 months. None of the bulkier sites of gross disease had local progression after combination therapy. This case suggests that the synergistic effect of PULSAR and anti-PD-1 immunotherapy is efficacious for relapsed or refractory metastatic melanoma in pediatric patients. Clinical trial number: not applicable.https://doi.org/10.1186/s13014-025-02691-yMetastatic melanomaPULSARPembrolizumabanti-PD-1anti-CTLA-4BRAF Inhibition |
| spellingShingle | Kyra L. McCarty Tanya Watt Tu D. Dan Robert D. Timmerman Kiran A. Kumar Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma Radiation Oncology Metastatic melanoma PULSAR Pembrolizumab anti-PD-1 anti-CTLA-4 BRAF Inhibition |
| title | Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| title_full | Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| title_fullStr | Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| title_full_unstemmed | Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| title_short | Use of PULSAR (personalized ultra-fractionated stereotactic adaptive radiotherapy) as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| title_sort | use of pulsar personalized ultra fractionated stereotactic adaptive radiotherapy as consolidation with immune checkpoint inhibition in the treatment of pediatric metastatic melanoma |
| topic | Metastatic melanoma PULSAR Pembrolizumab anti-PD-1 anti-CTLA-4 BRAF Inhibition |
| url | https://doi.org/10.1186/s13014-025-02691-y |
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