A man with severe skin cancer went into remission after having heart surgery. The operation is thought to have caused a major reset of his immune system that destroyed the tumour – but also caused him to develop a severe bee sting allergy.
“Something absolutely fascinating is happening with his immune system” says at The Ottawa Hospital in Canada, who wasn’t involved in the man’s treatment.
The man, who is in his 60s and lives in Australia, originally had a severe type of skin tumour, known as melanoma, removed from his chest. Subsequent tests suggested he had no remaining cancer.
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Eight months later, he was admitted to Royal Adelaide Hospital, Australia, with aortic stenosis, which occurs when a blood vessel in the heart becomes blocked with calcium, usually due to age. During an X-ray for the aortic stenosis, doctors noticed signs of cancer in his left armpit.
Further scans revealed he had severe melanoma that had spread across several lymph nodes, his liver and in his left thigh bone. “The diagnosis was not good, with not a good chance of 5 years,” said the man in a BMJ Case Report.
He was given the cancer drugs dabrafenib and trametinib to take at least once per day. But he stopped taking them after two months due to severe side effects, including liver damage. Later scans revealed the man’s tumours hadn’t responded to the drugs.
Around this time, he required surgery to treat his worsening aortic stenosis, which led to a bacterial infection. About two months after the operation, the man had another scan to monitor his cancer, which revealed his tumours had completely disappeared. “I was surprised, shocked and relieved to be told that the cancer was completely gone,” he said in the report. “I couldn’t hold my emotions in at all.”
at Adelaide University and at Royal Adelaide Hospital – who wrote the case report – have said that the tissue injury caused by the surgery, paired with the infection, may have caused cells around his heart to release pro-inflammatory molecules, such as cytokines. The pair, who declined to be interviewed, added that these may have activated cancer-fighting immune cells, such as T-cells.
These cells may not have received enough inflammatory signals naturally from the body to respond to the tumours, but were boosted by the surgery and infection, says at the Marshfield Clinic in Wisconsin.
Two years later, the man – who works as a farmer – developed anaphylaxis to a honeybee sting, despite being stung dozens of times before his heart surgery without a severe allergic reaction. “The new development of the bee venom allergy is particularly intriguing as a marker of a permanently reset immune system,” says Sharma.
More than 70 case studies have previously linked surgery to melanoma regression. A recent report also described how a biopsy of a tumour in a woman’s arm probably triggered an immune response that put her into remission.
“We do know that unusual immune reactions, whether it’s due to viruses, or vaccines or other major changes [like surgery], can really change the anti-tumour immune response and lead to surprising regressions,” says Auer.
Yet, have shown that surgery usually suppresses the immune system, leading to worse cancer outcomes, says Auer. This is due to the initial surge of pro-inflammatory molecules being quickly followed by a compensatory anti-inflammatory response, she says.
It is unclear why this man went into remission, but his response may be due to his genetics, says Auer. Better understanding this could reveal the pathways involved, which could one day be targeted with drugs, she says.
BMJ Case Reports
