title: Intralesional therapy for advanced melanoma: promise and limitation.
abstract: OBJECTIVE
  Patients with unresectable, multiple or advanced locally/regionally metastatic stage IIIB/C or stage IV M1a melanoma have a high risk for recurrence, progression and metastasis. The article reviews treatment advances for this population.
  
  
  RESULTS
  After promising phase 2 results with Allovectin-7 (velimogene aliplasmid), overall survival in a phase 3 study was shorter for Allovectin-7 than for dacarbazine/temozolomide (median 18.8 versus 24.1 months).In a phase 2 trial of intratumoral electroporation of plasmid interleukin-12 among 28 patients with advanced melanoma, the primary endpoint of best overall response rate within 24 weeks of first treatment was 32.2% for objective response and 10.7% for complete response.In the phase 3 OPTiM trial of talimogene laherparepvec, the intralesional agent that is furthest along in clinical testing, the primary endpoint of durable response rate was 16% for talimogene laherparepvec and 2% for granulocyte macrophage colony-stimulating factor.In the PV-10 phase 2 trial among 80 patients with stage III-IV melanoma, the overall response rate was 51%, with a 26% complete response rate.
  
  
  CONCLUSIONS
  Despite advances, many patients will need several lines of therapy. Some will not be eligible for systemic therapy. Their low toxicity, easy administration and likely systemic immune effects make intralesional therapies an attractive option.
authors: St. Luke's Cancer Center and Temple University, Bethlehem, Pennsylvania, USA.
authors: Sanjiv S
authors: SS
authors: Agarwala
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004274:DNA, Recombinant / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional; D008055:Lipids / Q000008:administration & dosage*; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012074:Remission Induction; D012878:Skin Neoplasms; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma
chemical_list: C096492:Allovectin-7; D000970:Antineoplastic Agents; D004274:DNA, Recombinant; D008055:Lipids
references: Cancer. 2004 Apr 15;100(8):1692-8
references: 15073858
references: Am J Dermatopathol. 1986 Aug;8(4):331-5
references: 3532854
references: Hum Gene Ther. 2005 Jan;16(1):35-48
references: 15703487
references: J Surg Oncol. 2014 Mar;109(4):296-300
references: 24249157
references: Carcinogenesis. 2012 Mar;33(3):687-93
references: 22219178
references: Cancer. 1975 Oct;36(4):1305-8
references: 1175129
references: J Surg Oncol. 2014 Mar;109(4):295
references: 24419862
references: J Surg Oncol. 2014 Mar;109(4):301-7
references: 24678530
references: J Surg Oncol. 2014 Mar;109(4):327-31
references: 24453036
references: Cancer. 1995 Jan 15;75(2 Suppl):726-34
references: 7805001
references: Med Clin North Am. 1976 May;60(3):473-97
references: 1271889
references: Semin Oncol. 1987 Mar;14(1):1-7
references: 3823915
references: Hum Gene Ther. 1993 Dec;4(6):703-11
references: 8186285
references: J Clin Oncol. 2009 Dec 1;27(34):5763-71
references: 19884534
references: Melanoma Res. 2008 Dec;18(6):405-11
references: 18830132
references: Melanoma Res. 2010 Jun;20(3):218-26
references: 20354459
references: J Surg Oncol. 2014 Mar;109(4):314-9
references: 24510477