Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2023; 11(24): 5830-5834
Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5830
Fecal transplantation in patient with metastatic melanoma refractory to immunotherapy: A case report
Auro del Giglio, Fabio Cesar Atui
Auro del Giglio, Department of Oncology, Faculdade de Medicina da Fundação ABC, Santo André 09060-870, São Paulo, Brazil
Fabio Cesar Atui, Department of Endoscopy, Hospital Sirio Libanês, São Paulo 01308-050, São Paulo, Brazil
Author contributions: del Giglio A took clinical care of the patient and wrote the draft of the report; Atui FC did the FMT on the patient described the procedure for publication.
Informed consent statement: Informed consent was obtained from the patient to publish the report and associated images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Auro del Giglio, MD, Professor, Department of Oncology, Faculdade de Medicina da Fundação ABC, Avenida Príncipe de Gales 821, Santo André 09060-870, São Paulo, Brazil. aurodelgiglio@gmail.com
Received: June 18, 2023
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Melanoma, Fecal microbiota transplantation, Immunotherapy resistance, Metastatic melanoma, Gut microbiome, Cancer, Case report

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.