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Current treatment of advanced (stage III, IV) melanoma utilizes immunotherapy (for BRAF mutation negative tumors), and immunotherapy and/or targeted therapy for BRAF mutation positive tumors. This has significantly improved prognosis in advanced melanoma. However, the technology is far from ideal. Significant cost and morbidity from immunotherapy are problems as it is currently constituted (blind use of high-dose T-cell stimulating drugs such as ipilimumab, pembrolizumab and nivolumab for prolonged periods of administration). A typical course of these drugs for one individual may exceed a half a million dollars over a two-year period; cost alone may limit further deployment of this technology to other tumor types. Another serious limitation of this excessive use of T-cell stimulation drugs are autoimmune side effects, which are increased by higher dosages and prolonged periods of administration. Pretreatment with adjuvant immunotherapy techniques such as laser immunotherapy (LIT), which combines laser irradiation and topical application of imiquimod, an immunoadjuvant, may provide a solution. LIT could potentiate the effectiveness of checkpoint inhibitors, thus significantly lowering the dose required and shortening the necessary period of administration. This, in turn, leads to a significant cost savings as well as dramatic reductions in morbidity from side effects, while simultaneously enhancing the effectiveness of treatment. Anecdotal evidence of these effects will be introduced and the further development of laser immunotherapy plus checkpoint inhibitors in the near future will be discussed.
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