title: In situ photoimmunotherapy: a tumour-directed treatment for melanoma.
abstract: We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 x 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American Joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) >20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma.
authors.affiliation: Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA. marknaylor@earthlink.net
authors.forename: M F
authors.initials: MF
authors.lastname: Naylor
authors.forename: W R
authors.initials: WR
authors.lastname: Chen
authors.forename: T K
authors.initials: TK
authors.lastname: Teague
authors.forename: L A
authors.initials: LA
authors.lastname: Perry
authors.forename: R E
authors.initials: RE
authors.lastname: Nordquist
mesh_terms: D000368:Aged; D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007259:Infrared Rays / Q000627:therapeutic use; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D051193:Toll-Like Receptors / Q000819:agonists* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; D051193:Toll-Like Receptors; D000077271:Imiquimod