Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
J Immunother Cancer. 2024 Nov 19;12(11):e009581. doi: 10.1136/jitc-2024-009581.
In-transit metastases of malignant melanoma pose a significant clinical challenge, particularly in patients with contraindications to systemic therapies. While surgical excision and systemic immunotherapies remain standard treatments, localized therapies such as intralesional talimogene laherparepvec (T-VEC) and topical imiquimod, which stimulate tumor-specific T-cell responses, have garnered increasing attention for their potential efficacy and tolerability. Although the individual efficacy of these therapies is well-documented, their combined use and their synergistic effects have not been well-documented. This case series reports on five patients with in-transit melanoma metastases treated with T-VEC and imiquimod at Northwestern Memorial Hospital from November 2018 to May 2023. Patients received a median of 13 (range 8-20) T-VEC injections over a median of 6 months (range 5-9), of which 4 of those months were with concurrent T-VEC and imiquimod cream. Four of the five patients achieved complete response (CR) by the end of the treatment course. One patient developed systemic progression during therapy, leading to early cessation of treatment. All patients with CR elected to continue topical imiquimod applications as maintenance following T-VEC for a median of 6 months (range 2-14 months). Only one of the four patients who achieved CR developed metastatic nodal disease 10 months after the last T-VEC injection. The three other patients are free of cutaneous and systemic disease 2-57 months after their last injection. All patients tolerated treatment well with zero patients discontinuing treatment due to side effects. These findings suggest that the combination of intralesional T-VEC and topical imiquimod can be an effective and safe treatment of in-transit metastases of malignant melanoma.
转移性黑色素瘤在运输过程中构成重大的临床挑战，尤其在存在全身治疗禁忌的患者中。虽然手术切除和全身免疫疗法仍是标准治疗方法，但局部治疗方法，如瘤内注射替莫唑胺拉帕霉素（T-VEC）和外用咪喹莫特，可刺激肿瘤特异性 T 细胞反应，已越来越受到关注，因其潜在疗效和耐受性。虽然这些治疗方法的单独疗效已有充分记录，但它们的联合应用及其协同作用尚未得到充分记录。本病例系列报告了 5 名在西北纪念医院接受 T-VEC 和咪喹莫特治疗的转移性黑色素瘤患者。患者接受了中位数为 13 次（范围 8-20 次）的 T-VEC 注射，中位数为 6 个月（范围 5-9 个月），其中 4 个月同时使用 T-VEC 和咪喹莫特乳膏。5 名患者中有 4 名在治疗结束时达到完全缓解（CR）。1 名患者在治疗期间出现全身进展，导致提前停止治疗。所有达到 CR 的患者均选择在 T-VEC 后继续使用咪喹莫特乳膏进行维持治疗，中位数为 6 个月（范围 2-14 个月）。在最后一次 T-VEC 注射后 10 个月，仅 1 名达到 CR 的患者发生淋巴结转移性疾病。另外 3 名患者在最后一次注射后 2-57 个月无皮肤和全身疾病。所有患者均耐受良好，无因副作用而停止治疗的患者。这些发现表明，瘤内注射 T-VEC 和外用咪喹莫特的联合治疗可能是治疗转移性黑色素瘤的有效和安全方法。
