Neoadjuvant Immunotherapy in High Risk Patients with Cutaneous Melanoma: A Novel Approach

Elias EG

Former Professor of Surgery & Oncology, University of Maryland School of Medicine, USA

^*Correspondance to: E. George Elias 

 PDF  Full Text Research Article | Open Access

Abstract:

Cutaneous melanoma is an immunogenic tumor, but it seems to be very heterogeneous. Utilizing patient own tumor, before it excision, as the source for tumor-specific antigens, intratumoral administration of low dose of GM-CSF weekly in dermal and subdermal metastases did result in over 50% response rate. Failure to establish complete tumor response (CR), low weekly dose of IL-2 was substituted and resulted in CR. Therefore, it seemed that some melanoma lesions did therapeutically respond to intratumoral GM-CSF therapy, while other lesions required Intratumoral IL-2. Each of these two cytokines has different mechanism of action that may complement one another. Therefore, sequential administration of GM-CSF followed by IL-2, once at the primary site of deeply invasive primary melanoma, one week prior to its resection (Neoadjuvant Approach), did induce massive antitumor immune response at the injection sites. Such an immune response did result in complete tumor necrosis with massive histiocytosis. In addition, there was an overexpression of a great number of immune cells at the injection sites as well as in some regional lymph nodes. This autologous approach seemed to overcome tumor heterogeneity. The overall duration of response ranged from 31- over 60 months to the last date of contact. In conclusion, in vivo autoimmunization of melanoma sites (prior to its excision) by intratumoral administration of these two cytokines seemed to induce an immense antitumor response without major side effects, and such immune response was transmitted via the lymphatics. Such an approach seemed to prolong patient survival.

Keywords:

Preoperative intratumoral cytokine therapy; Survival benefits

Cite the Article:

Elias EG. Neoadjuvant Immunotherapy in High Risk Patients with Cutaneous Melanoma: A Novel Approach. Clin Oncol. 2016; 1: 1060.