Zusammenfassung
Multiple kutane Satelliten- und In-Transit-Metastasen maligner Melanome ohne begleitende Lymphknoten- oder Fernmetastasierung stellen insbesondere bei älteren inoperablen Patienten mit internistischen Grunderkrankungen eine therapeutische Herausforderung dar. In dieser besonderen Situation bietet die intraläsionale Behandlung mit Interleukin-2 eine effiziente, nebenwirkungsarme und auch ambulant durchführbare Alternative zur systemischen Chemo- oder Zytokintherapie. Wir berichten über 2 ältere Patientinnen mit multiplen kutanen Filiae eines malignen Melanoms, bei denen es nach intra- und periläsionaler Applikation von Interleukin-2 (3-mal 6–12 Mio. IE) über einen Zeitraum von 12 Wochen zu einer kompletten Remission der Metastasen kam. In Biopsien zur Kontrolle des Therapieerfolges ließen sich keine vitalen Tumorzellen mehr nachweisen. Die Therapie wurde in beiden Fällen, abgesehen von einem leichten Brennen an der Injektionsstelle und einer inflammatorischen Umgebungsreaktion über wenige Tage, unter Begleittherapie mit 500 mg Paracetamol und Vorbehandlung der Injektionsstelle mit einer lidocain- und prilocainhaltigen Creme subjektiv gut vertragen. Systemische Nebenwirkungen traten nicht auf.
Abstract
Multiple cutaneous satellite and in-transit metastases of melanoma without involvement of lymph nodes or other organs are a challenge especially when they occur in elderly inoperable patients with multiple internal diseases. In this particular situation, intralesional application of interleukin-2 may represent an effective alternative to systemic chemo- or immunotherapy as it can be performed on an out-patient basis and has few side effects. We treated two elderly female patients with multiple cutaneous metastases of malignant melanoma with intra- and perilesional application of interleukin-2 (3×6–12 Mio IE) over 12 weeks and achieved a complete remission of these metastases. In follow-up biopsies, no viable tumor cells were found. Despite a slight burning at the injection side and a transient local inflammatory reaction, the therapy was well tolerated in both cases after premedication with paracetamol 500 mg orally and pretreatment of the injection site with a cream containing lidocaine and prilocaine. No systemic side effects were observed.
Literatur
Assmann K, Nashan D, Grabbe S et al. (2002) Persistent inflammatory reaction at the injection site of IL-2 with lymphoma-like inflammatory infiltrates. Hautarzt 53:554–557
Garbe C (1995) Perspectives of cytokine treatment in malignant skin tumors. Recent Results Cancer Res 139:349–369
Gehl J, Geertsen PF (2000) Efficient palliation of haemorrhaging malignant melanoma skin metastases by electrochemotherapy. Melanoma Res 10:585–589
Gutwald J, Groth W, Mahrle G (1994) Peritumoral administered IL-2-induced tumor regression in melanoma. Pilot study. Hautarzt 45:536–540
Hauschild A, Garbe C, Stolz W et al. (2001) Dacarbazine and interferon alpha with or without interleukin 2 in metastatic melanoma: a randomized phase III multicenter trial of the Dermatologic Cooperative Oncology Group (DeCOG). Br J Cancer 84:1036–1042
Keilholz U, Conradt C, Legha SS et al. (1998) Results of interleukin-2-based treatment in advanced melanoma: a case record-based analysis of 631 patients. J Clin Oncol 19:2921–2929
Kian Ang K, Geara FB, Byers RM, Peters LJ (1998) Radiotherapy for melanoma. In: Balch CM, Houghton AN, Sober AJ, Soong SJ (eds) Cutaneous melanoma. Quality Medical Publishing Inc., St. Louis, pp 389–401
Lejeune FJ (2002) The impact of surgery on the course of melanoma. Recent Results Cancer Res 160:151–157
Noorda EM, Vrouenraets BC, Nieweg OE et al. (2002) Safety and efficacy of isolated limb perfusion in elderly melanoma patients. Ann Surg Oncol 9:968–974
Ridolfi L, Ridolfi R, Ascari-Raccagni A et al. (2001) Intralesional granulocyte-monocyte colony-stimulating factor followed by subcutaneous interleukin-2 in metastastic melanoma: a pilot study in elderly patients. J Eur Acad Dermatol Venerol 15:218–223
Rosenberg SA, Lotze MT, Muul LM et al. (1985) Observations in the systemic administration of autologous lymphocine-activated killer cells and recombinant interleukin-2 to patients with metastatic cancer. N Engl J Med 313:1485–1492
Strobbe LJ, Nieweg OE, Kroon BB (1997) Carbon dioxide laser for cutaneous melanoma metastases: indications and limitations. Eur J Surg Oncol 23:435–438
Ugurel S, Wagner A, Pföhler C et al. (2002) Topical imiquimod eradicates metastases of malignant melanoma but fails to prevent rapid lymphogenious metastatic spread. Br J Dermatol 147:621–624
Vrouenraets BC, Klaase JM, Kroon BB et al. (1995) Long-term morbidity after regional isolated perfusion with melphalan for melanoma of the limbs. The influence of acute regional toxic reactions. Arch Surg 130:43–47
West WH, Tauer KW, Yanelli JR et al. (1987) Constant-infusion of recombinant interleukin-2 in adoptive immunotherapy of advanced cancer. N Engl J Med 316:898–905
Wolf ICH, Smolle J, Binder B et al. (2003) Topical imiquimod in the treatment of metastatic melanoma to skin. Arch Dermatol 139:273–276
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Pföhler, C., Steinhäuser, S., Wagner, A. et al. Komplette Remission kutaner Satelliten- und In-transit-Filiae nach intraläsionaler Interleukin-2-Applikation bei 2 Patienten mit malignem Melanom. Hautarzt 55, 171–175 (2004). https://doi.org/10.1007/s00105-003-0620-4
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DOI: https://doi.org/10.1007/s00105-003-0620-4