Focus on: Il melanoma oggi

Immunologia del melanoma
Martin C. Mihm, Jr., M.D., FACP, FRCPI, (Boston USA)

A variety of different vaccination techniques have been utilized in the treatment of melanoma including whole tumor cells, dendritic cells and peptides among others. In preliminary findings in experiments with melanoma bearing-mice vaccinated with tumor cells transfected with DNA to produce GMCSF we found 100% tumor destruction. Based on these experiments we designed a trial in humans with Stage IV melanoma wherein patients were vaccinated with cells transfected first by retrovirus and then later by adenovirus that resulted in production of high levels of GMCSF. A marked local reaction ensued as did reactions at different sites. It was clear that the response included ctyotosic CD8 positive T cells, high levels of antibody directed against melanoma cells as well as T cells toxic to tumor vasculature. The latter lymphocytes interaction resulted in endothelial cell death with associated tumor necrosis. Of 28 ptients who recieved the whole vaccination course there was one complete remission two partial remissions and 25 patients exhibited stable disease. Their median survival was 3 ½ years. A detailed analysis of the vaccination technique, the ractions and the survival will be presented.