PMC8600981_01
(A) Patient's evolution including diagnosis, disease recurrence, mixed response during pembrolizumab, and disease progression to pembrolizumab. (B) Radiological assessment baseline and after three cycles (after 18 weeks): patient presented supraclavicular, mediastinal, lombo-aortic, inguinal lymph nodes, and a vulvar metastasis before treatment. After 18 weeks/three cycles of treatment, a partial response was observed. However, in the previously irradiated field, tumor continued to grow up.
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Computed tomography (CT) scan showed metastatic disease at multiple lymph nodes and both lungs ( Figure 1B ). TL including subcarinal lymph node (15 mm), retrocaval lymph node (14 mm), and superior right lobe lesion (0 mm) and an increase of +22% in the vulvar mass (50 mm) ( Figure 1B ). The CT scan showed neither an increase of NTL nor the appearance of any other new lesions.
(A) Population of T cells in anal canal (baseline), vulvar lesion (PL), and cervical lymph node (RL). (B) Macrophage/monocyte presence (A) and PD-L1 expression (B) were evaluated at diagnosis in the anal canal (primary tumor) and during treatment with anti-PD-1 agent in the vulvar lesion (progressive lesion) and in the cervical lymph node (responsive lesion).
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CD8(+), and CD4(+)CD25(+)FOXP3(+), CD8/CD3, and CD8/FOXP3 ratios in the three settings are represented on  Figure 2A . CD8/CD3 T-cell ratio was 35.6 in the anal canal, 58.7 in the PL, and 65.1 in the RL. CD8/FOXP3 T cell ratio was <1% in the anal canal, 1.82 in the PL, and 50.26 in the RL ( Figure 2A ). PL, and high expression in the RL. PD-L1 expression was found to be low in the anal canal, moderate in the PL, and high in the RL ( Figure 2B ).