Melanoma vaccines: breakthrough or bust?

The role of vaccine therapy in the treatment of melanoma

BACKGROUND

Melanoma is a tumour that is usually resistant to systemic therapy. Since it has been considered to be a highly immunogenic tumour, it has become an excellent target for the active specific immunotherapy. Vaccine therapy represents a novel approach to the treatment of melanoma.

OBJECTIVE

To evaluate different vaccines tested in stage III and/or IV melanoma patients.

METHODS

Systematic review of the published evidence on vaccine therapy in melanoma.

RESULTS

Melanoma vaccines can be classified into six groups: whole-cell vaccines, dendritic cell vaccines, peptide vaccines, ganglioside vaccines, DNA vaccines and viral vectors. The main characteristics of these vaccines including their advantages and disadvantages and the results from conducted trials are presented. Clinical responses to melanoma vaccines are still poor and currently there is no melanoma vaccine with a proven efficacy.

CONCLUSION

Vaccine therapy still remains an experimental therapy in patients with metastatic melanoma. Further research is required although a future therapy for advanced melanoma is probably a multimodal approach including vaccines, adjuvants and negative co-stimulatory blockade.

Results of clinical trials with an allogeneic melanoma tumor cell lysate vaccine: Melacine®

The identification of proteins and carbohydrates associated with melanoma led to development of defined antigen vaccines. However, vaccines derived from whole allogeneic cells have a number of advantages. Melacine is an allogeneic melanoma tumor cell lysate combined with an immunologic adjuvant, DETOX. Phase I and II trials in stage IV melanoma showed low-level antitumor activity, but this vaccine has its greatest promise in the adjuvant setting. A phase III trial indicated a survival benefit for Melacine in the subset of melanoma patients who express the HLA class I antigens A2 and/or HLA-C3. This finding must now be prospectively confirmed.