Espinosa, E. (E.)
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- SEOM clinical guideline for the management of malignant melanoma (2017)(Springer, 2018) Gonzalez-Larriba, J.L. (José Luis); Soria, A. (Ainara); Espinosa, E. (E.); Martin-Algarra, S. (Salvador); Cao, M.G. (M. G.); Arance, A. (Ana); Marquez-Rodas, I. (Iván); Cruz, L. (L.) de la; Castellon, V.E. (V. E.); Berrocal, A. (Alfonso)All melanoma suspected patients must be confirmed histologically and resected. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon could be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 containing therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 containing therapy. Up to 10 years follow up is reasonable for melanoma patients with dermatologic examinations and physical exams.
- Immunotherapy of distant metastatic disease(Oxford University Press (OUP), 2009-08) Espinosa, E. (E.); Martin-Algarra, S. (Salvador); Cinat, G. (G.); Petrella, T. (T.); Schadendorf, D. (D.); Guo, J. (J.); Dreno, B. (B.); Schachter, J. (J.); Hauschild, A. (A.); Bastholt, L. (L.); Eggermont, A.M. (Alexander M.); Hersey, P. (P.)Immunotherapy of metastatic melanoma consists of various approaches leading to specific or non-specific immunomodulation. The use of FDA-approved interleukin (IL)-2 alone, in combination with interferon alpha, and/or with various chemotherapeutic agents (biochemotherapy) is associated with significant toxicity and poor efficacy that does not improve overall survival of 96% of patients. Many studies with allogeneic and autologous vaccines have demonstrated no clinical benefit, and some randomised trials even showed a detrimental effect in the vaccine arm. The ongoing effort to develop melanoma vaccines based on dendritic cells and peptides is driven by advances in understanding antigen presentation and processing, and by new techniques of vaccine preparation, stabilisation and delivery. Several agents that have shown promising activity in metastatic melanoma including IL-21 and monoclonal antibodies targeting cytotoxic T lymphocyte-associated antigen 4 (anti-CTLA-4) or CD137 are discussed. Recent advances of intratumour gene transfer technologies and adoptive immunotherapy, which represents a promising although technically challenging direction, are also discussed.