Signal transduction inhibitors and anticheckpoint
antibodies have significantly improved survival for metastatic
melanoma patients, but most still die within 5 years.
Vaccine approaches to induce immunity to well-characterized
melanoma-associated
antigens, or to
antigens expressed on allogeneic tumor cell lines, have not resulted in approved agents. Despite the limitations associated with the immunosuppressive tumor microenvironment, there now is one intralesional autologous
vaccine approved for patients who have primarily soft-tissue
metastases. There is continued interest in patient-specific
vaccines, especially dendritic cell
vaccines that utilize ex vivo loading of
autologous antigen, thus bypassing certain in vivo immunosuppressive cells and
cytokines. Because of their mechanism of action and limited toxicity, they are potentially synergistic or additive to other antimelanoma
therapies.