Metastatic melanoma of the skin today remains a difficult task. A revolution in treatment was the emergence of new classes of drugs: inhibitors of regulatory molecules of the key stages of the immune response and tyrokinase receptors, which in mono-mode showed an advantage compared to standard treatment regimens, and their combination is objectively better result compared to mono-mode. Genetic profiling was indispensable for choosing personalized treatment approaches. In the absence of treatment standards for patients with advanced MK, local doctors rely on individual clinical cases, trying to classify them into similar clinical scenarios, which differ in each case. Some authors recommend that these scenarios be included in clinical trials, either as inclusion criteria or stratification factors. Thus, this approach may be a way of personalizing the treatment of patients with MMC. Materials and methods. A 29-year-old patient with MK back surgery was operated on with subsequent adjuvant immunotherapy. When the disease progressed, the patient was prescribed sequentially immuno-, chemo- and combination therapy with anti-CTL4 + PD-1 inhibitors, sanitary excision of soft tissue metastases, a combination of BRAF + MEK inhibitors, polychemotherapy. Results. The personalized therapy of the patient with MMC has led to an increase in the overall duration and quality of life. Conclusion. Despite the consistent application of the majority of the known available treatment regimens to the patient, stabilization of the condition was only possible for a short time. To achieve a complete or partial response to any of the types of treatment failed. But this case can be considered a variant of personalized therapy, which allowed to slow down the development of the disease, keep the patient in good health and a long time, an active lifestyle, improve its quality, which is already a great achievement. The life expectancy without progression in this patient was 9 months, the total life expectancy from the start of treatment was 44 months.
Personalized therapy with peptide-based neoantigen vaccine (EVX-01) including a novel adjuvant, CAF®09b, in patients with metastatic melanoma
