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Supplementary materials and methods

Supplementary Figures 1-6. Suppl. Fig. 1. Mel-ILP induces release of certain cytokines, however does not affect infiltration of immune cells into tumor bed. Suppl. Fig. 2. Melphalan induces apoptosis of melanoma cells. Suppl. Fig. 3 Melphalan induces exposure of danger signals. Suppl. Fig. 4. Dying human melanoma cells induce danger signaling-independent in vitro stimulation of immune cells. Suppl. Fig. 5. In vitro treated melanoma cells do not strongly activate NK cells. Suppl. Fig. 6. (A) The phenotypic maturation of murine iDCs (B) Effect of antibodybased elimination of CD4+ and CD8+ cells in prophylactic mice vaccination experiment

Supplementary Tables 1-3. Supplementary Table 1. Meta-data analysis of clinical response to melphalan-based isolated limbtreatment procedures in melanoma patients. Supplementary Table 2. Meta-data analysis of clinical response to melphalan/TNF or Mel/TNF/IFNγ combination therapies for isolated limb-treatment procedures in melanoma patients. Supplementary Table 3. Follow up information about the patients whose tumour samples were used for analysis of infiltration of immune cells and expression levels of cytokines.

Systemic chemotherapy generally has been considered immunosuppressive, but it has become evident that certain chemotherapeutic drugs elicit immunogenic danger signals in dying cancer cells that can incite protective antitumor immunity. In this study, we investigated whether locoregionally applied therapies, such as melphalan, used in limb perfusion for melanoma (Mel-ILP) produce related immunogenic effects. In human melanoma biopsies, Mel-ILP treatment upregulated IL1B, IL8, and IL6 associated with their release in patients' locoregional sera. Although induction of apoptosis in melanoma cells by melphalan in vitro did not elicit threshold levels of endoplasmic reticulum and reactive oxygen species stress associated with danger signals, such as induction of cell-surface calreticulin, prophylactic immunization and T-cell depletion experiments showed that melphalan administration in vivo could stimulate a CD8+ T cell–dependent protective antitumor response. Interestingly, the vaccination effect was potentiated in combination with exogenous calreticulin, but not tumor necrosis factor, a cytokine often combined with Mel-ILP. Our results illustrate how melphalan triggers inflammatory cell death that can be leveraged by immunomodulators such as the danger signal calreticulin. Cancer Res; 75(8); 1603–14. ©2015 AACR.