Efficacité du facteur de nécrose tumorale-α (rTNF-α) associé à Pinterféron-γ et à la chimiothérapie en circulation extracorporelle du membre isolé dans le mélanome malin, les sarcomes des tissus mous et les carcinomes épidermoïdes inopérables. Expérience de 4 années

The authors review their experience of 4 years with isolated limb perfusion for the application of high dose TNF-α associated to IFN-γ and melphalan for the treatment of regionally advanced tumours such as malignant melanoma, soft tissue sarcoma and epidermoid carcinoma. In malignant melanoma, the complete remission rate reaches 91%. In irresectable soft tissue sarcoma, this treatment when used as a neoadjuvant treatment saves the limb from amputation in 87.5% of the cases. Similar results are obtained for epidermoid carcinoma. With the regional application of high doses of TNF-α associated to chemotherapy and IFN-γ, it has been possible to validate the concept of a strategy based on a dual targeting, that is the selective impact of the intratumoral vessels by TNF-α and of the tumour cells by chemotherapy. This approach appears to be the treatment of choice for locally advanced tumours of the limbs. However, as a single therapy, this procedure should be considered in melanoma as an induction therapy, and in sarcoma, as a preoperative treatment.