Intralesional therapy for metastatic melanoma.
BACKGROUND
Intralesional therapy for metastatic melanoma has some advantages over systemic therapy. Local drug administration allows for delivery of an increased concentration of the agent and reduced systemic exposure, thereby increasing local efficacy and limiting toxicity. Moreover, since in vivo tumor nodules contain the tumor antigens, this tumor tissue may serve as an autologous vaccine to induce systemic immunity. This so-called 'bystander effect', where uninjected distant lesions exhibit a response, has been reported in select intralesional therapy trials.


METHODS
This review will give an overview of the working mechanisms, clinical evidence and side effects for available intralesional and topical therapies and summarize the most recent developments in this field.


CONCLUSIONS
The ideal treatment approach for locoregionally advanced melanoma should be multidisciplinary and tailored to the patient, taking into consideration patient-related, tumor-related factors (such as location, tumor burden, mutation status) and previous treatments received. It will likely not be a single therapy, but rather a combination of injectable treatments, regional perfusions and systemic therapies.
University Medical Center Groningen , Groningen , Netherlands.
Sarah
S
Sloot
Omar M
OM
Rashid
Jonathan S
JS
Zager
D000287:Administration, Topical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D053672:Electrochemotherapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D036502:Infusions, Intralesional; D008545:Melanoma / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
in-transit melanoma; intralesional; locoregional recurrence; melanoma