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Melanoma

The Role of Intralesional Therapies in Melanoma

Sanjiv S. Agarwala, MD
Through the emergence of new immunotherapies, treatment of melanoma is undergoing a long-awaited revolution. Ongoing research will clarify the outlines of the place that intralesional therapies will occupy in the therapeutic armamentarium in the years ahead.

Melanoma

Adding total body irradiation to chemotherapy prior to the adoptive cell transfer of TILs had no effect on tumor regression in patients with metastatic melanoma.

Treatment with the anti–PD-1 antibody pembrolizumab yielded good long-term survival outcomes in a phase Ib trial of patients with advanced melanoma.

Through the emergence of new immunotherapies, treatment of melanoma is undergoing a long-awaited revolution. Ongoing research will clarify the outlines of the place that intralesional therapies will occupy in the therapeutic armamentarium in the years ahead.

Perhaps the greatest attraction and chief benefit of intratumoral therapies is their ability to synergize with systemic checkpoint therapies and accelerate the development of a lymphoid infiltrate and perhaps secondary lymphoid structures in vivo, which in turn can result in systemic mobilization of a T-cell response: the local injection–global effect model.

A recent trial found no survival difference in patients with melanoma with a positive sentinel lymph node biopsy who underwent complete lymph node dissection compared with those who did not undergo dissection. However, the trial failed to achieve the required number of events and is, therefore, underpowered.

More than one-third of patients with advanced melanoma were still alive 5 years after starting treatment with the anti-PD-1 immunotherapy nivolumab, according to long-term phase I data.

A new study has shown that algorithms of dermoscopic criteria used to detect melanoma had only modest levels of accuracy and lacked interobserver agreement among a group of regular dermoscopy users.

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