Cytokines - current status and perspectives in the treatment of skin tumors

Various therapeutic options using cytokines have been described in the trea tment of melanoma, T cell lymphoma, B cell lymphoma, squamous cell carcinom a, basal cell carcinoma and Merkel cell carcinoma. The treatment regimens i nclude cytokine substitution,cytokine induction, cytokine transfection and therapeutic cytokine constructs. In the adjuvant treatment of melanomas, IFN-alpha has become well establish ed. Statistical evaluations of different adjuvant trials show that a signif icant prolongation of recurrence-free intervals can be achieved. IL-2 has a role in the therapy of advanced melanomas as well as in vaccination strate gies. Further possible therapeutic immune modulations,which. have been eval uated in experimental approaches and pilot studies, include treatment with IL-4, IL-7 and GM-CSF. Treatment with IL-12 promises to open new perspectiv es. A well established regimen in the treatment of T cell lymphoma stages Ia-II b is the combination of PUVA and IFN-alpha. In vitro data also indicate an important (patho)physiological role for IL-12,so that this agent has been t ested in phase I studies. IL-2, IFN-gamma, and the fused cytokine-toxin mol ecules DAB(389)IL-2 offer further therapeutic alternatives. B cell lymphoma s are treated with antibody-IL-2 fusion proteins. Advanced or inoperable squamous cell carcinoma and basal cell carcinoma may be treated with local IFN-alpha injections. IFN-alpha or TNF-alpha may be considered for the treatment of recurrent or advanced Merkel cell carcinoma . In dermatological oncology cytokine treatment focuses on melanome an T cell lymphome. Cytokine application is mainly an integral part of multimodal re gimens.