Locoregionally advanced and metastatic melanoma represent a challenging clinical problem, but in the era of immune checkpoint blockade and intralesional and infusional therapies, more options are available for use. Isolated limb infusion (ILI) was first introduced in the 1990s for the management of advanced melanoma, followed by the utilization of isolated extremity perfusion (ILP). Following this, intralesional oncolytic viruses, xanthene dyes, and cytokines were introduced for the management of in-transit metastases as well as unresectable, advanced melanoma. In 2015, the Food and Drug Administration (FDA) approved the first oncolytic intralesional therapy, talimogene laherparepvec (T-VEC), for the treatment of advanced melanoma. Additionally, immune checkpoint inhibition has demonstrated efficacy in the management of advanced melanomas, and this improvement in outcomes has been extrapolated to aid in the management of in-transit metastatic disease. Finally, percutaneous hepatic perfusion (PHP), also approved by the FDA, has been reported to have a significant impact on the treatment of hepatic disease in uveal melanoma. While some of these treatments have less utility due to inferior outcomes as well as higher toxicity profiles, there are selective patient profiles for which these therapies carry a role. This review highlights intralesional and infusional therapies for the management of metastatic melanoma.
局部晚期和转移性黑色素瘤是临床治疗中的一大难题，但在免疫检查点阻断、病灶内注射及灌注治疗的时代背景下，现已拥有更多治疗选择。孤立肢体灌注（ILI）于20世纪90年代首次应用于晚期黑色素瘤的治疗，随后发展为孤立肢体热灌注（ILP）。此后，病灶内溶瘤病毒、呫吨类染料及细胞因子相继被用于治疗移行转移及不可切除的晚期黑色素瘤。2015年，美国食品药品监督管理局（FDA）批准了首个病灶内溶瘤疗法——他利莫基因拉赫帕雷普维（T-VEC）用于晚期黑色素瘤治疗。此外，免疫检查点抑制剂在晚期黑色素瘤治疗中已证实具有显著疗效，其疗效提升的经验已被推广应用于移行转移性疾病的治疗。最后，经皮肝灌注（PHP）同样获得FDA批准，据报道对葡萄膜黑色素瘤肝转移的治疗具有重要影响。尽管部分疗法因疗效欠佳或毒性较高而应用受限，但针对特定患者群体这些治疗仍具有应用价值。本综述重点探讨了用于转移性黑色素瘤治疗的病灶内注射及灌注疗法。
Intralesional and Infusional Updates for Metastatic Melanoma
肿瘤(癌症)患者之家