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Malignant melanoma remains a difficult clinical problem. Chemotherapy is not effective and immunotherapy has long been contemplated as the preferred approach to this disease. Extensive passive and active immunotherapy trials have been conducted. Active vaccination with whole cells or defined antigens, administered with a panoply of techniques to increase immunogenicity, has yielded inconsistent results. The development of antibody-based vaccines has allowed vaccination without the need for tumor tissue material or purified antigens. The idiotype network theory originally proposed by Lindemann and by Jerne provided the basis for the development of anti-idiotype (anti-Id) antibody vaccines, which mimic the internal image of the epitope targeted for immunization. Preclinical and phase I clinical data are available for various malignancies. In melanoma, some of the anti-Id vaccines have targeted gangliosides. One of these vaccines, TriGem, has been successful in generating a robust and specific humoral immunity in melanoma patients. Phase II data suggest this anti-Id vaccine has clinical activity., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

A 46-year-old man with a history of metastatic transitional cell carcinoma of the bladder received treatment with ifosfamide/mesna. He had reversible encephalopathy after the first cycle of chemotherapy. Adequate clinical response was achieved, with an obvious decrease in tumor size. Subsequently, an identical treatment was given without adverse central nervous system effects. Few data exist about retreatment with intravenous ifosfamide/mesna after induced encephalopathy, but this case suggests that this adverse effect may not recur in some patients.