In situ photoimmunotherapy:: a tumour-directed treatment for melanoma
In situ photoimmunotherapy:: a tumour-directed treatment for melanoma
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DOI：
10.1111/j.1365-2133.2006.07514.x
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发表时间：
2006-12-01
影响因子：
10.3
通讯作者：
Nordquist, R. E.
中科院分区：
文献类型：
--
作者：
Naylor, M. F.;Chen, W. R.;Nordquist, R. E.
我们报告了一种新的免疫治疗晚期皮肤黑色素瘤，结合激光刺激与局部应用的Toll样受体激动剂。这种治疗，原位光免疫疗法（ISPI），提供了一种替代传统疗法的黑色素瘤患者皮肤转移。对位于指定的20 X 20 cm治疗区域中的皮肤转移进行6周周期的ISPI：每天两次局部应用咪喹莫特（在塑料封闭下的5%乳膏）进行2周预处理，在第2周和第4周再次进行激光治疗。局部咪喹莫特持续整个6周周期。2例晚期黑色素瘤患者接受了ISPI治疗。患者1在左臂上具有原发性肿瘤和局部转移，以及肺中的转移性肿瘤[美国癌症联合委员会（AJCC）IV期]。患者2患有头颈部黑色素瘤伴多发性局部转移（AJCC IIIC期），多次尝试手术切除和高剂量放射治疗均失败。在第一个治疗周期后> 20个月，患者1现在没有所有临床上可检测的肿瘤（包括肺转移）。患者2已经超过6个月没有任何肿瘤的临床证据。这两个病例表明，ISPI可以清除局部肿瘤并引发有益的全身反应，其副作用与晚期黑色素瘤的其他治疗方法相比更为有利。
We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 X 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) > 20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma.