Intra‐lesional interleukin‐2 therapy for in transit melanoma

Temple‐Oberle, Claire; Byers, Brett; Hurdle, Valerie; Fyfe, Allison; McKinnon, J. Gregory

doi:10.1002/jso.23556

Cited by 34 publications

(18 citation statements)

References 39 publications

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“…Common systemic effects include fever and other flu-like symptoms (chills, fatigue, nausea, and emesis, sometimes stomach pain, diarrhea, and headache) that are usually mild and often respond to analgesics. 105,106,108 Less Common Intralesional Injection Agents: IFN has been used as an intralesional injection agent for treating in-transit melanoma, although there is very little published evidence to support this approach (case reports and one small retrospective study 109 ). Intralesional bacillus Calmette-Guérin (BCG) has been shown to provide at least transient complete or partial responses in most injected lesions, with much higher response rates in cutaneous versus subcutaneous metastases (Table 3).…”

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confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

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OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

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mentioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

View full text Add to dashboard Cite

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“…The intralesional injection of IL‐2 has recently shown complete response rates of 50%, similar to our study. However, it is accompanied by pain and/or intralesional erythema, fever, nausea and influenza‐like symptoms in 25–85% of patients treated, it requires administration several times a week for several months at the hospital, premedication and short‐term medical observation after completion, all of which are unnecessary with CRY‐IQ …”

Section: Discussionmentioning

confidence: 99%

“…However, it is accompanied by pain and/or intralesional erythema, fever, nausea and influenza-like symptoms in 25-85% of patients treated, it requires administration several times a week for several months at the hospital, premedication and short-term medical observation after completion, all of which are unnecessary with CRY-IQ. 3 Topical imiquimod has proven useful in the management of LCMM in isolated cases and small series. 11,12 A complete response rate of 20% was found in combination with 5-fluorouracil in a series of five cases.…”

Section: Discussionmentioning

confidence: 99%

“…Local laser ablation or radiation therapy should be reserved for selected patients and/or those with unresectable symptomatic lesions. In patients with multiple in‐transit lesions located in the extremities, isolated limb infusion/perfusion with melphalan is the preferable therapeutic option …”

Section: Introductionmentioning

confidence: 99%

“…In patients with multiple in-transit lesions located in the extremities, isolated limb infusion/perfusion with melphalan is the preferable therapeutic option. [3][4][5][6][7] Concomitant use of cryotherapy and imiquimod (cryoimmunotherapy) has been described for the treatment of other skin cancers such as basal cell carcinoma, Bowen's disease and (melanoma) lentigo maligna. 8,9 Furthermore, imiquimod improved on the systemic immune response induced by the cryosurgical destruction of melanoma lesions in murine models.…”

Section: Introductionmentioning

confidence: 99%

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Local cryosurgery and imiquimod: A successful combination for the treatment of locoregional cutaneous metastasis of melanoma: A case series

Rivas-Tolosa

Ortiz‐Brugués

Toledo-Pastrana

et al. 2015

The Journal of Dermatology

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Locoregional cutaneous metastases of melanoma (LCMM) represent a therapeutic challenge. Many treatment options are available with varying results. The combination of cryotherapy and imiquimod, two treatments with a possible synergistic effect, has not yet been described for treating this disease. In this paper, we aimed to show the response of LCMM to cryotherapy combined with topical imiquimod 5%. A retrospective review of 20 patients diagnosed with LCMM and treated with cryotherapy combined with topical imiquimod 5% between November 2000 and May 2014 at three institutions was performed. The locoregional cutaneous response was evaluated. After a mean of five sessions, 13 patients (65%) responded to treatment, eight (40%) of these completely and five (25%) partially. Systemic disease progressed in 16 (80%) patients. Cryotherapy followed by topical imiquimod 5% is simple to apply, has minimal adverse effects and provides response rates similar to other, more complex treatment options.

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Lesional therapies for in‐transit melanoma

Nadler

Hong

Alavi

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: To describe the outcomes of lesional therapy of in-transit melanoma (ITM) with interleukin-2 (IL-2), diphencyprone (DPCP), combination lesional therapy (IL-2, retinoid, and imiquimod; CLT), and imiquimod. Methods: Data was collected for consecutive patients with ITM receiving lesional therapies from 2008 to 2018 in a retrospective review. Included patients did not have metastatic disease at time of starting on lesional therapy and were not on systemic therapy. The primary outcome was complete pathologic response (pCR). Results: Of 83 patients, 57 (69%) started treatment with IL-2, 10 (12%) with DPCP, 12 (14%) with CLT, and 4 (5%) with imiquimod. pCR was achieved in 34 patients (41%) overall, including 44% starting on IL-2, 20% on DPCP, 58% on CLT, and none on imiquimod (P = .024). With a median follow-up of 45 months, cumulative one-year overall survival was 86%, with the best survival in the CLT group. Forty-eight percent experienced common terminology criteria for adverse events grade 1 or 2 toxicity. A quarter of patients on DPCP discontinued therapy due to toxicity (P = .002). Conclusions: IL-2 may be considered for the treatment of ITM with multiple or rapidly developing lesions where there would otherwise be significant morbidity with surgery, given pCR rates and toxicity.

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Intra‐lesional interleukin‐2 therapy for in transit melanoma

Cited by 34 publications

References 39 publications

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Local cryosurgery and imiquimod: A successful combination for the treatment of locoregional cutaneous metastasis of melanoma: A case series

Lesional therapies for in‐transit melanoma

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