Melanoma is a cancer of the skin that usually begins in the form of a mole. The cancer typically grows deep into the skin and then spreads to different parts of the body through blood or lymph vessels. It usually spreads first to lymph nodes that are near the site where the cancer started. When advanced, it can spread to organs and other lymph nodes throughout the body. While surgery is an essential component for the treatment of most melanoma patients, some patients may benefit from additional treatment with biological therapy following surgery.

Advanced melanoma (cancer that has spread from its site of origin) is considered to be a very deadly cancer. Current chemotherapy and radiation generally do not have significant anti-cancer activity against this disease; therefore research efforts have been focused on newer types of treatments which include biological therapy. Biological therapy is a type of therapy that utilizes the body’s immune system to attack cancer. Vaccines are one type of biological therapy. While some vaccines offer promise for many patients, they do not produce optimal anti-cancer effects in all patients. Reports from a recent clinical trial published in

Annals of Oncology indicate that a new skin test may help physicians predict the effectiveness of vaccines as treatment for patients with melanoma.

Recently, researchers conducted a clinical trial to determine whether local skin reactions at the site of the vaccination injection could be used to predict a patient’s long-term response to the treatment. The researchers discovered an association between signs of early immune activity (red and/or indented skin) at the site of injection and a decreased risk of cancer recurrence. In this clinical trial, 81 patients with advanced melanoma received a minimum of 3 vaccinations following surgical removal of their cancer. Researchers were able to establish a clear association between the size of redness and/or induration of the skin and a patient’s long-term outcomes. The larger the area of redness or induration that occurred following injection, the greater chance a patient had for long-term survival.

By using this skin test, physicians may be able to predict whether a patient will derive long-term benefit to biological vaccinations. A vaccine is one type of biological therapy that is currently being evaluated in clinical trials for the treatment of melanoma. Vaccines work by stimulating a patient’s immune system to recognize and attack cancer cells in the body. A healthy immune system will detect and attack cancer cells that are present in the body. Normally, the immune system recognizes cancer cells by identifying unique proteins that are displayed on the surface of these cells, called antigens. Once the immune system recognizes a cancer cell, it mounts an immune-mediated attack to kill the cell. Part of the problem with melanoma is that the cancer cells fail to provoke an immune response.

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The production of the tumor cell-BCG vaccine begins with a sample of cancer cells that have been surgically removed from a patient. The cancer cells are treated so that they become inactive, or dead. They are then mixed with an inactive bacteria called BCG. Through this mixing process, these combined cells display antigens that are specific to both BCG and melanoma cells. These combined cells are then infused back into the patient. These BCG antigens help the immune system to immediately recognize the cells as foreign. A significant component of this process is that the immune system also recognizes as foreign the antigens on the cells that are specific to the patient’s melanoma cells. This prompts the immune system to attack any cell displaying melanoma antigens in the body.

Results from the skin test can help guide physicians in determining whether patients should include biological vaccines in their treatment program. For patients with an insignificant early immune response, vaccinations may not be appropriate and other treatment options should be considered to derive optimal benefits. Further clinical trials need to be performed in order to confirm these results. Patients with melanoma may wish to discuss the risks and benefits of participating in a clinical trial utilizing vaccination therapy or other promising new treatment strategies. Two sources of ongoing information include comprehensive, easy-to-use services provided by the National Cancer Institute

(cancer.gov) and

eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (

Annals of Oncology, Vol 11, No 8, pp 965-970, 2000)

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