IMMUNOTHERAPY, INCLUDING GENE-THERAPY, FOR METASTATIC MELANOMA

Current standard therapy for distant metastatic melanoma is ineffectiv e and often compromises the quality of a patient's life. Immunotherapy is briefly reviewed in relation to its many forms: from local non-spe cific to the more recent specific vaccines, including those using spec ific melanoma peptides ie,g. from the proteins encoded by melanoma-ass ociated gene (MAGE)) and those involving genetically transduced autolo gous melanoma cells using retroviral vectors in vitro. The mode of act ion of genetically transduced melanoma cells incorporating the granulo cyte macrophage colony stimulating factor (GM-CSF) gene (GVAX) is pres ented as a paradigm for cytokine-mediated strategies. Trials of GVAX a nd other cytokine gene strategies are under way in Brisbane, Boston an d Amsterdam, and some interim perspectives on the clinical outcomes an d immunological mechanisms involved are sketched, Some of the compound ing problems in immunotherapeutic strategies for cancer are iden- tifi ed, and possible adjunct manoeuvres for overcoming them are discussed.