Melanoma is a type of
skin cancer arising from melanocytes and is increasing in incidence. Although complete surgical excision of early stage lesions may be curative, metastatic
melanoma continues to be a major therapeutic challenge. Advances in understanding the molecular pathways that promote
tumorigenesis and the interactions between
melanoma cells and the immune system have resulted in the approval of several newly targeted agents and
immunotherapy strategies for the treatment of advanced disease. Oncolytic virus
immunotherapy is a new approach that uses native or attenuated live viruses to selectively kill
melanoma cells and induce systemic
tumor-specific immune responses. A variety of viruses are now in clinical development with the attenuated oncolytic herpesvirus encoding
granulocyte-macrophage colony stimulating factor, known as
talimogene laherparepvec, recently demonstrating an improvement in durable response rate in patients with advanced
melanoma compared with
granulocyte-macrophage colony stimulating factor alone. A major advantage of
talimogene laherparepvec and related agents is the limited toxicity and ability to use each individual
tumor as a source of
antigen to generate a highly specific antitumor immune response. These agents are easily administered in the out-patient setting and may be a reasonable option for patients with limited metastatic
tumor burden, those with a good performance status and without extensive prior treatment, and in those who cannot tolerate more difficult therapeutic regimens. Further investigation into the impact on overall survival as monotherapy and combination of oncolytic virus
immunotherapy with other forms of
immunotherapy merit high priority for further clinical application of these novel agents for the treatment of
melanoma and perhaps other
cancers as well.