A Case of Metastatic Melanoma Refractory to Immunotherapy: Is Cytotoxic Chemotherapy Still an Effective Option?

Metastatic melanoma is traditionally associated with poor responses to conventional cytotoxic chemotherapy. Although there has been a shift in paradigm in melanoma treatment in the last few decades with the use of targeted treatment and immunotherapy, there is a significant subset of patients who are treatment refractory. Interestingly, some of these patients may derive meaningful benefit from cytotoxic chemotherapy. We present the report of a case of a 63-year-old lady with BRAF wild type, locally advanced mucosal melanoma who demonstrated disease progression on combination immunotherapy with Ipilimumab and nivolumab. She subsequently achieved an exceptional and durable radiological and clinical response to chemotherapy with cisplatin and dacarbazine. This case highlights that, despite advances in personalized medicine and immunotherapy, conventional chemotherapy may still represent a valuable therapeutic option in selected patients, particularly in the refractory setting.