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Karl D. Lewis, MD


Rare Case of Metastatic Cutaneous Adnexal Tumor Treated With Pembrolizumab

By: Sarah Campen, PharmD
Posted: Friday, April 1, 2022

A case study presented in JNCCN–Journal of the National Comprehensive Cancer Network described reportedly the first case of metastatic spiradenocarcinoma managed with a PD-1 inhibitor. Skin adnexal spiradenomas are typically benign; however, they can degenerate into aggressive spiradenocarcinomas. “With only 117 malignant cases reported, treatment recommendations are based on case reports and expert opinion,” explained Jeffrey J. Wargo, MD, of The Ohio State University Wexner Medical Center, Columbus, and colleagues.

A 64-year-old woman presented with a recent, rapid growth of a nodule on her right upper arm. The growth had been present for 15 years but had recently started changing.

Histopathologic examination showed features of classic spiradenoma, and further testing revealed right-sided lung metastases and lymph node involvement in the right axilla. She was diagnosed with metastatic spiradenocarcinoma with negative estrogen and progesterone receptor expression but high expression of PD-L1.

Carboplatin and paclitaxel were administered every 3 weeks for four cycles, but the disease progressed in the right lung. Pembrolizumab at 200 mg was initiated intravenously once every 3 weeks; after 6 months, the lung metastases decreased in size. Over the next several months, however, she experienced disease progression, including brain metastasis, regrowth of lung metastases, and metastasis to the peritoneum with bowel obstruction—despite continuation of pembrolizumab for three more cycles, the addition of paclitaxel, and three cycles of oral capecitabine. Further therapy with gemcitabine and docetaxel was initiated, but the patient died of the disease within 1 month.

Although PD-1 inhibition was not curative in this case, the authors noted that the patient initially improved with pembrolizumab. “The mixed response we observed might offer a glimpse of hope for patients with metastatic spiradenocarcinoma,” they concluded.

Disclosure: The study authors reported no conflicts of interest.

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