Intralesional and Infusional Therapies for Metastatic Melanoma

Melanoma is a serious form of skin cancer that begins in the pigment-producing cells (melanocytes) that give the skin its color. Although the cancer often develops on parts of the body that receive frequent sun exposure—such as the face, arms, legs and back—it can also occur in less obvious locations, including the palms of the hands, soles of the feet and beds of the nails. Certain factors may increase the risk of developing melanoma, including fair skin, frequent or prolonged ultraviolet (UV) exposure, an abundance of moles, a personal history of sunburns and a family history of melanoma.

Although skin cancer can occur at any age, melanoma is most often diagnosed in adults 50 and older. Early warning signs usually involve visible skin irregularities, such as a new mole or an existing mole that changes in size, shape or color. Mole features such as irregular borders, uneven shading and rapid enlargement should be discussed with a physician promptly. After examining the skin, the physician may perform a biopsy of the suspicious tissue to confirm the diagnosis. Melanoma treatment often involves a combination of therapies, such as surgery, immunotherapy, targeted therapy, radiation therapy and/or chemotherapy, with the specific regimen tailored to the stage and spread of the cancer.

Metastatic melanoma is an advanced stage of skin cancer that occurs when melanoma cells spread from the original tumor site to distant organs, lymph nodes or other tissues. Intralesional or infusional therapy may be considered for metastatic melanoma that cannot be completely removed through surgery. Instead of exposing the entire body to systemic therapy, these novel treatments deliver a therapeutic substance directly to a tumor or a specific region of the body. Intralesional or infusional therapy may be a good option for a tumor that is limited to a limb, the skin or the liver, particularly when other therapies have been unsuccessful.

While new agents are currently under investigation, we are also investigating the role of combining these therapies with systemic agents to enhance outcomes. There is a lot of opportunity in this space to improve patient outcomes.

Matthew Perez, MD

What do intralesional and infusional therapies for metastatic melanoma involve?

Intralesional therapy is injected directly into a melanoma tumor. The best-known example is talimogene laherparepvec (T-VEC), an oncolytic virus approved by the U.S. Food and Drug Administration (FDA) for the treatment of unresectable melanoma on the surface of the skin (cutaneous), under the skin (subcutaneous) or in a lymph node (nodal). T-VEC works by entering the tumor cells, causing them to break down and stimulating an immune response against the cancer. Other intralesional treatments currently under evaluation in clinical trials include modified viruses and immune-activating compounds that may further boost the body’s ability to fight melanoma.

Infusional therapy delivers a high dose of chemotherapy to a confined part of the body. Techniques include:

• Isolated limb infusion (ILI) – This procedure involves temporarily restricting blood flow to an arm or leg with a tourniquet, allowing the chemotherapy drugs to circulate only within that limb. ILI may be used for a patient with multiple melanoma tumors on a limb that cannot be surgically removed.
• Percutaneous hepatic perfusion (PHP) – This approach isolates the liver’s blood supply and infuses high-dose chemotherapy directly into the organ. It can be particularly beneficial for a patient with melanoma that predominantly affects the liver, such as metastatic uveal melanoma.

Both infusional therapy methods are designed to concentrate treatment where it is needed most, while reducing exposure to the rest of the body.

What are the potential benefits of intralesional and infusional therapies?

The primary advantage of intralesional and infusional therapy for metastatic melanoma is the ability to target the treatment directly to the area of the body most affected by the cancer. This focused delivery approach allows for a higher dose of therapy with fewer systemic side effects. For a patient with metastatic melanoma that has not responded to standard treatments, intralesional or infusional therapy may offer local tumor control, which can help reduce symptoms and enhance the patient’s quality of life. In some cases, these therapies may also be given in combination with systemic treatments, such as immunotherapy, to achieve a more durable response.

What are the possible side effects of intralesional and infusional therapies?

The side effects of intralesional and infusional therapies can vary depending on the treatment method and the area of the body treated. Intralesional therapies may cause localized redness, swelling and discomfort at the injection site. Treatments such as T-VEC can also cause flu-like symptoms, such as fever and fatigue.

Isolated limb infusion may cause temporary pain, swelling and inflammation in the treated limb. Though rare, compromised circulation can lead to tissue damage. Because percutaneous hepatic perfusion targets the liver, side effects may include abdominal pain, changes in liver function and vascular complications related to catheter use.

Although side effects are possible, intralesional and infusional therapies are specifically designed to limit whole-body toxicity. The patient will be carefully monitored during and after treatment to ensure that any complications can be addressed promptly.

What is recovery like?

Recovery can vary depending on the type of therapy received. Intralesional injections are usually administered in an outpatient setting, allowing most patients to return home the same day with minimal downtime. Infusional therapies, such as ILI and PHP, are more complex and often require hospital observation immediately afterward. The patient may need a short recovery period to manage any side effects and ensure stable organ function. Through periodic follow-up visits and imaging tests, the physician can track the effectiveness of treatment and guide the next phase of care. Most patients can gradually resume their normal routine as their recovery progresses.

Benefit from world-class care at Moffitt Cancer Center

If you would like to learn more about intralesional and infusional therapies for metastatic melanoma, you can request an appointment with a specialist in the comprehensive Cutaneous Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.