Several areas of immunotherapeutic research may ultimately improve the effectiveness of active specific
immunotherapy for
melanoma and other
malignancies. Identification of the most relevant
tumor antigens will continue to be a vital component of
vaccine design. Optimizing delivery of these
antigens by use of adjuvants, dendritic cells, or
heat shock proteins will enhance the immunogenicity of
vaccines. The use of
DNA vaccines to deliver
nucleotides that encode relevant
antigens and immunologic molecules, such as costimulatory molecules, and the use of targeted
therapy with immunocytokines have yielded promising results in animal studies. Finally, cutting-edge techniques such as quantitative polymerase chain reaction and gene/
protein microarrays will be used to monitor the response to a
vaccine and thereby guide management decisions. Although IFN-alpha 2b is the only FDA-approved adjuvant treatment for AJCC stage IIB/III
melanoma, recent data failed to show a benefit in overall survival. For patients with AJCC stage IV
melanoma,
chemotherapy with
dacarbazine is currently the standard of care, with modest response rates of 15% to 20%. The encouraging response rates and low toxicities that were reported in phase I/III trials suggest that active immunotherapy may prove to be the most effective adjuvant
therapy. At present, there are no FDA-approved
cancer vaccines for
malignant melanoma, and the results of ongoing randomized phase III clinical trials are greatly anticipated.