13. Immunogenetherapy combined with brain metastases irradiation in melanoma patients

Abstract

Aims

To assess toxicity and results of melanoma brain metastases irradiation in patients treated with genetically modified tumour vaccine.

Materials/methods

A group of 45 melanoma stage IV (AJCC) patients was treated with vaccine consisted of autologic melanoma cells admixed with allogeneic cells modified with IL-6 and slL-6R genes. During the treatment 14 patients developed symptoms of brain metastases. 5 patients had solitary metastases, 9 multiple lesions. 4 patients with single metastasis were treated surgically. All 14 patients were irradiated with the doses 30–39 Gy, using 3 Gy/fracion, 5 fractions/week. Toxicity of cranial irradiation (clinically, CT) and clinical results (CT, survival) were evaluated. Immunological cellular responses were assessed in vitro.

Results

Acute effects of irradiation were tolerable and manageable using standard dexamethasone treatment. There was no radiation encephalopathy or radiation necrosis. In 7/14 patients stabilization or partial remission of brain lesions was observed. Overall survival measured from brain metastases diagnosis ranged from 2 to 21 months (2 patients are still alive), median survival was 316 days. In 4 treated patients radiation enhanced immune responses to the vaccine.

Conclusions

Palliative cranial irradiation is well tolerated by patients treated with novel systemic approaches such as immunogene therapy, relives symptoms and may extend survival. Radiation of metastases modulates immune responses to melanoma cells.