Kokoschka E M, Micksche M
Wien Klin Wochenschr. 1977 Sep 30;89(18):612-22.
Immunological investigations in malignant melanoma have demonstrated the important role of immunological defence mechanisms in the control of tumour growth and tumour spread. On the basis of the different test systems for investigation of immunecompetence and tumourspecific immunity it was possible to demonstrate that patients with melanoma, especially of clinical stages II and III, have a weak, sometimes an anergic immune reaction against their own tumour. The information obtained from in vitro and in vivo studies in human on tumour immunity formed the rational basis for immunotherapy in malignant melanoma. Increasing evidence suggests that active non-specific immunotherapy and, especially, active specific immune-stimulation with inactivated melanoma cells can delay the appearance of distant metastases and result in an improved survival rate for patients with involved regional lymph nodes. At present the use of involved chemotherapy is mostly confined to patients with disseminated malignant melanoma. The most extensively used chemotherapeutic agent for treatment of melanoma is the DTIC (dimethyl-triaceno-imidazole-carboxamide). The objective response rate with this monotherapy has been reported to be up to 25%. Nitrosoureas (BCNU, CCNU, MECCNU) have also been widely used and have brought clinical responses similar to DTIC. Experimental studies in animal models and investigation in human have demonstrated that chemotherapy can be combined successfully with immunotherapy with a potential additive, perhaps synergistic, effect.
恶性黑色素瘤的免疫学研究表明，免疫防御机制在控制肿瘤生长和扩散中发挥着重要作用。基于用于研究免疫能力和肿瘤特异性免疫的不同测试系统，已证实黑色素瘤患者，尤其是临床II期和III期患者，对自身肿瘤的免疫反应较弱，有时甚至无反应。从人体肿瘤免疫的体外和体内研究中获得的信息，构成了恶性黑色素瘤免疫治疗的合理依据。越来越多的证据表明，主动非特异性免疫治疗，尤其是用灭活的黑色素瘤细胞进行主动特异性免疫刺激，可以延迟远处转移的出现，并提高区域淋巴结受累患者的生存率。目前，联合化疗主要用于播散性恶性黑色素瘤患者。治疗黑色素瘤最广泛使用的化疗药物是达卡巴嗪（DTIC，即二甲基三氮烯咪唑甲酰胺）。据报道，这种单一疗法的客观缓解率高达25%。亚硝基脲类药物（卡莫司汀、洛莫司汀、司莫司汀）也已被广泛使用，并带来了与达卡巴嗪相似的临床反应。动物模型的实验研究和人体研究表明，化疗可以与免疫治疗成功联合，可能具有相加甚至协同作用。
