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Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
Published on: January 25, 2015
Metastatic melanoma - a review of current and future treatment options
Emanual Maverakis1, Lynn A Cornelius, Glen M Bowen
1Department of Dermatology, University of California Davis, School of Medicine, 3301 C Street, Suite 1400, Davis, 95816 Sacramento, USA. emaverakis@ucdavis.edu.
Abstract:
Despite advances in treatment and surveillance, melanoma continues to claim approximately 9,000 lives in the US annually (SEER 2013). The National Comprehensive Cancer Network currently recommends ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma. Little data exists to guide management of cutaneous and subcutaneous metastases despite the fact that they are relatively common. Existing options include intralesional Bacillus Calmette-Guérin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation therapy, interferon therapy, and intratumoral interleukin-2 injections. Newly emerging treatments include the anti-programmed cell death 1 receptor agents (nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec). Available treatments for select sites include adoptive T cell therapies and dendritic cell vaccines. In addition to reviewing the above agents and their mechanisms of action, this review will also focus on combination therapy as these strategies have shown promising results in clinical trials for metastatic melanoma treatment.
Insights
Melanoma treatment advances are ongoing, yet metastatic melanoma remains a significant threat. This review details current and emerging therapies, including combination strategies, for managing advanced melanoma, particularly cutaneous and subcutaneous metastases.
Area of Science:
- Oncology
- Dermatology
- Immunology
Background:
- Melanoma, particularly Stage IV, presents significant treatment challenges despite advances.
- Cutaneous and subcutaneous metastases are common but have limited established management guidelines.
- Current first-line treatments for Stage IV melanoma include ipilimumab, vemurafenib, dabrafenib, and high-dose IL-2.
Purpose of the Study:
- To review current and emerging treatment options for metastatic melanoma.
- To focus on the management of cutaneous and subcutaneous melanoma metastases.
- To explore the role of combination therapy in advanced melanoma treatment.
Main Methods:
- Comprehensive literature review of existing and novel melanoma therapies.
- Analysis of treatment mechanisms of action for various agents.
- Evaluation of clinical trial data for combination therapies.
Main Results:
- Established treatments include intralesional Bacillus Calmette-Guérin, isolated limb perfusion/infusion, interferon-α, and others.
- Emerging therapies encompass anti-programmed cell death 1 receptor agents (nivolumab, pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec).
- Adoptive T cell therapies and dendritic cell vaccines are available for select cases.
Conclusions:
- A wide array of treatment modalities exists for metastatic melanoma.
- Combination therapies show promise and are a key focus for improving patient outcomes.
- Further research is needed to optimize the management of cutaneous and subcutaneous metastases.
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