title: Perilesional injection of r-GM-CSF in patients with cutaneous melanoma metastases.
abstract: Based on evidence that granulocyte-macrophage colony stimulating factor (GM-CSF) induces a potent systemic antitumor immunity, we tested recombinant GM-CSF in advanced melanoma. Seven patients with histologically confirmed cutaneous melanoma metastases were treated with perilesional intracutaneous injections of recombinant GM-CSF and observed for a follow-up time of 5 y. All but two patients had a decrease in the total number of metastases. At the end of the 5 y follow-up three of the seven patients are still alive with only one patient receiving other than surgical therapy, and one patient died tumor free at the age of 93. The remaining three patients died from progressive melanoma. Perilesional intradermal GM-CSF therapy resulted in a mean survival time of 33 mo. The treatment was well tolerated and no side-effects other than local erythema at the injection sites and mild drowsiness were seen. Immunohistochemical analysis with staining for CD14 and GM-CSF receptor demonstrated an increased infiltration of monocytes into both injected and noninjected cutaneous melanoma metastases compared with lesions excised prior to the initiation of therapy. The same was true for CD4- and CD8-positive lymphocytes. This phenomenon, together with GM-CSF-induced leukocyte counts of more than 20,000 during therapy, support the possible impact of a systemic over a locally induced reaction by GM-CSF. To our knowledge this is the first report that intracutaneously injected GM-CSF results in long-lasting reduction of melanoma metastases.
authors.affiliation: Department of Dermatology, Division of General Dermatology, University of Vienna, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Hoeller
authors.forename: B
authors.initials: B
authors.lastname: Jansen
authors.forename: E
authors.initials: E
authors.lastname: Heere-Ress
authors.forename: T
authors.initials: T
authors.lastname: Pustelnik
authors.forename: U
authors.initials: U
authors.lastname: Mossbacher
authors.forename: H
authors.initials: H
authors.lastname: Schlagbauer-Wadl
authors.forename: K
authors.initials: K
authors.lastname: Wolff
authors.forename: H
authors.initials: H
authors.lastname: Pehamberger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008545:Melanoma / Q000737:chemistry / Q000188:drug therapy* / Q000556:secondary; D058950:Melanoma-Specific Antigens; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D016187:Receptors, Granulocyte-Macrophage Colony-Stimulating Factor / Q000032:analysis; D011994:Recombinant Proteins / Q000008:administration & dosage; D012878:Skin Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000556:secondary; D016896:Treatment Outcome
chemical_list: D000951:Antigens, Neoplasm; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; D016187:Receptors, Granulocyte-Macrophage Colony-Stimulating Factor; D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor