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Therapeutics in Dermatology
A reference textbook in dermatology

Anticancer vaccination

6 June 2012, by KNOL A.-C. & QUEREUX G. & LABARRIERE N. & KHAMMARI A.

In dermatology, in terms of anticancer vaccination, two treatment strategies have been developed for melanoma patients with locoregional recurrence or metastatic disease: immunotherapy and chemotherapy. For over ten years, little progress has been made in the use of chemotherapy for the treatment of melanoma. The fact that Déticène® is still considered to be the reference molecule despite its 20 percent response rate is the proof of this. It is also important to note that two recent major clinical breakthroughs, anti-CTLA4 antibodies and BRAF inhibitors, will certainly have an impact on the development of vaccines for melanoma. Together with immunotherapy, these promising emerging therapies will have to be taken into account in the long term treatment of melanoma.

The use of vaccines in melanoma is based on:

- the fact that spontaneous regression of primary melanomas or cutaneous metastases has been reported in the literature, suggesting that the immune system plays an important role in the development of these tumours;

- the identification of a large number of specific melanoma cell antigens, making vaccination a viable option.

1 - DEFINITION

Two mechanisms are involved in anticancer immunotherapy:

- passive immunotherapy, or cell therapy which consists in extracting T lymphocytes from the tumour, amplifying them to obtain several billion cells and re-injecting these cells into the patient. This is therefore an autologous system and, since the T cells are isolated from the site of the tumour, it is presumed that they are tumour antigen-specific;

- active immunotherapy, or vaccination.

Once the melanoma-specific antigens have been identified, the aim of "anti-melanoma" vaccination is to induce a specific immune response by injecting these antigens back into the patient with a view to initiating tumour cell rejection.

In addition to the spontaneously regressing lesions observed, this strategy is supported by the existence of a peritumoral lymphocyte infiltrate and the delayed recurrences, sometimes more than ten years after removal of the primary tumour, reported.

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