Nathanson L
J Cutan Pathol. 1979 Jun;6(3):213-26. doi: 10.1111/j.1600-0560.1979.tb01126.x.
Malignant melanoma is a disease characterized by clinical evidence of host defense, possibly immunologically mediated. It is a disease which tends to be refractory to both radiotherapy and chemotherapy. Immunotherapy has been used in three phases of the disease. 1. Intralesional immunotherapy with a nonspecific immune adjuvant in patients with local intradermal or soft tissue recurrence. This treatment produces approximately 15% regression of both injected and uninjected lesions, and about 60% regression of injected lesions only. Both clinical and laboratory evidence suggests that this regression is immunologically mediated. 2. Patients with surgical removal of all clinically demonstrable tumor, either primary disease alone or regional node recurrence, active nonspecific, and specific, immunotherapy has been used in an adjuvant setting. There is considerable controversy about the benefits accruing to such immunotherapy, but most large scale prospective and randomized studies have suggested that if benefit does result it is modest in degree and probably cannot be measured in terms of increase in cure rate. 3. Immunotherapy has also been used as a nonspecific active adjuvant to single drug or polychemotherapy in patients with disseminated melanoma. Whereas complete response rate may be slightly increased by this maneuver there is no convincing evidence that immunotherapy markedly increases the total objective response rate to polychemotherapy, and survival is only marginally superior when immunotherapy is added to chemotherapy in this setting. Further studies need to be done with active specific immunotherapy with tumor cell membrane extracts; as an adjuvant in patients with minimal body burden of tumor cells; and to study the inaction between chemotherapy and immunotherapy in this disease. Furthermore, studies of chemically defined fractions of either bacterial cell wall or tumor cell extracts must be evaluated both in terms of their ability to augment cell mediated immune responses in the melanoma patient, and also in terms of their ability to induce objective benefit for the patient. The possible use of immunotherapy in patients with primary melanoma has been briefly explored but needs further study. Possible additive effects with radiotherapy and immunotherapy should also be looked at in this disease utilizing high dose fractions and other new forms of radiotherapeutic technique.
恶性黑色素瘤是一种以宿主防御的临床证据为特征的疾病，可能是由免疫介导的。它是一种对放疗和化疗都往往难以治疗的疾病。免疫疗法已用于该疾病的三个阶段。1. 对局部皮内或软组织复发的患者，采用非特异性免疫佐剂进行病灶内免疫治疗。这种治疗使注射和未注射的病灶约有15%消退，仅注射病灶约有60%消退。临床和实验室证据均表明这种消退是由免疫介导的。2. 对于手术切除所有临床可证实肿瘤的患者，无论是单独的原发性疾病还是区域淋巴结复发，在辅助治疗中使用了主动非特异性和特异性免疫疗法。对于这种免疫疗法的益处存在相当大的争议，但大多数大规模前瞻性和随机研究表明，如果确实有益处，其程度也很有限，可能无法用治愈率的提高来衡量。3. 免疫疗法也已作为非特异性主动佐剂用于转移性黑色素瘤患者的单药或多药化疗。虽然这种方法可能会使完全缓解率略有提高，但没有令人信服的证据表明免疫疗法能显著提高对多药化疗的总体客观缓解率，并且在这种情况下将免疫疗法添加到化疗中时，生存期仅略有延长。需要对使用肿瘤细胞膜提取物进行主动特异性免疫疗法做进一步研究；作为肿瘤细胞负荷最小的患者的辅助治疗；以及研究这种疾病中化疗和免疫疗法之间的相互作用。此外，必须评估细菌细胞壁或肿瘤细胞提取物的化学定义成分，既要评估它们增强黑色素瘤患者细胞介导免疫反应的能力，也要评估它们为患者带来客观益处的能力。对原发性黑色素瘤患者使用免疫疗法的可能性已进行了简要探讨，但仍需进一步研究。在这种疾病中，还应利用高剂量分割和其他新的放射治疗技术研究放疗和免疫疗法可能的相加作用。
