Next generation of immunotherapy for melanoma

Regression of melanoma metastases following treatment with the n-bisphosphonate zoledronate and localised radiotherapy

We report a case of regression of pulmonary and bony metastases in a patient with malignant melanoma following palliative treatment with systemic zoledronate and localised radiotherapy to the bone. Zoledronate is a potent new bisphosphonate used for the treatment of metabolic bone diseases including bone metastases due to its inhibitory effect on osteoclasts. In the context of metastatic cancer zoledronate is routinely used to improve bone pain and reduce the frequency of skeletal events. There is also an increasing body of evidence suggesting that bisphosphonates exhibit anti-tumour properties. Bisphosphonates are able to activate Vgamma9Vdelta2 gamma-delta T cells which can be key players in the immune defence against malignant cells. Furthermore bisphosphonates have direct anti-proliferative, anti-metastatic and pro-apoptotic effects on tumour cells. These actions, together with their low side effect profile, may prove to be useful therapeutic tools in the treatment of cancer even in the absence of bone metastases. On the basis of this case report we here review the current literature on present preclinical and clinical studies using bisphosphonates for the treatment of cancer.

Dendritic cell-based human immunodeficiency virus vaccine

Dendritic cells (DC) have profound abilities to induce and coordinate T-cell immunity. This makes them ideal biological agents for use in immunotherapeutic strategies to augment T-cell immunity to HIV infection. Current clinical trials are administering DC-HIV antigen preparations carried out ex vivo as proof of principle that DC immunotherapy is safe and efficacious in HIV-infected patients. These trials are largely dependent on preclinical studies that will provide knowledge and guidance about the types of DC, form of HIV antigen, method of DC maturation, route of DC administration, measures of anti-HIV immune function and ultimately control of HIV replication. Additionally, promising immunotherapy approaches are being developed based on targeting of DC with HIV antigens in vivo. The objective is to define a safe and effective strategy for enhancing control of HIV infection in patients undergoing antiretroviral therapy.

Does pegylated interferon alpha-2b confer additional benefit in the adjuvant treatment of high-risk melanoma?

High-dose interferon (IFN)alpha-2b has shown benefits in the adjuvant treatment of melanoma, but relapse-free and overall survival remain poor, despite the use of chemotherapy, vaccines, and combinations of these modalities. Questions remain in relation to the relative importance of dose, route and duration of immunotherapy needed to prevent relapse and improve survival. Our understanding of STAT signaling, the role of dendritic and T cells and of circulating cytokine profiles in this benefit of IFN therapy have yet to be deployed clinically. The EORTC 18991 trial analyzed whether pegylated IFNalpha-2b delivered for up to 5 years could improve tolerability and efficacy of IFN. The study demonstrated an improvement in a subset of patients with microscopic disease, but not in those with gross nodal involvement. The potential role of this agent needs to be examined in relation to the long-term control of relapse. Assessment of the molecular, immunological, and antiangiogenic effects of the various forms of pegylated IFN will be critical to identification of the best future applications for these modalities.