Supplementary Material for: Exceptional Response of Therapy-resistant SF3B1 Mutant Conjunctival Melanoma to Nivolumab/LAG3 Inhibitor Relatlimab Combination Therapy: A Case Report

Introduction: Patients with conjunctival melanoma face high rates of recurrence and metastasis, leading to significant morbidity and mortality. Previous reports have shown successful responses to either anti-PD-1, anti-CTLA-4, or combination therapy for metastatic conjunctival melanoma. However, effective new treatments are needed due to inadequate disease response or adverse effects to therapy. Case Presentation: A 43-year-old male was diagnosed with right eye conjunctival melanoma and underwent resection. The melanoma was confirmed in the right lower conjunctiva, eyelid, and the right inferior parotid lymph node was positive for SF3B1 mutation positive metastatic melanoma. The patient was started on nivolumab monotherapy, but developed local and systemic recurrence. Subsequent treatment with combination ipilimumab and nivolumab combination therapy had to be discontinued shortly after due to colitis. Nivolumab/relatlimab combination therapy was initiated and resulted in an exceptional response, leading to regression of the conjunctival melanoma, shrinkage of metastatic lymph nodes, and stabilization of lung disease. Conclusion: To our knowledge, this is the first reported case demonstrating nivolumab/relatlimab efficacy in treating therapy-resistant conjunctival melanoma after failing nivolumab single-therapy.