Intralesional treatment for advanced melanoma: what’s on the horizon?

Advances in treatment of melanoma with systemic immunotherapies continue, with promising findings for anti-PD-1 agents combined with ipilimumab. Still, an unmet need persists because of populations ineligible for systemic immunotherapies, incomplete cure/response rates, toxicities and extreme costs. Also, potential for effective use of intralesional therapies remains, especially for local regional disease, but also for benefits of local ablation and adjuvant systemic host tumor-specific responses. Clinical trials of T-VEC, PV-10, CAVATAK and electroporation with plasmid IL-12 have demonstrated favorable, durable responses. Initial experience combining T-VEC, the agent furthest along in testing, with ipilimumab revealed higher complete and overall response rates than with either agent alone. Intralesional therapies may offer a treatment tool in the growing therapeutic armamentarium against this lethal disease.

Heightened interest in melanoma is occasioned by a few converging factors. Certainly contributing is the amazing emergence of effective systemic immunotherapies. They have lifted melanoma from the shadows of a lack-of-survival-benefit obscurity in just a few years to a current status in which complaints can be heard that dramatic immunotherapy research findings are attracting an excessive share of the limelight. The fact that melanoma incidence, while constituting a mere 2% of skin cancers, continues to rise (as it has over at least the last 30 years) and causes most skin cancer deaths [1] likely counts heavily, as well. Interest in intralesional therapies for melanoma, while still at a nascent stage, is being fed by impressive clinical research and maturing data suggesting that several strategies have potential utility among subsets of melanoma patients.

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