Systemic Therapy for Cutaneous Melanoma
Section snippets
Adjuvant therapy for melanoma
The majority of patients who present with melanoma have early stage disease, with 62.6% presenting with stage 0 or I disease, and an additional 23.1% with stage II disease.2 The standard therapy for localized melanoma is surgical resection. However, the relatively high rate of recurrence in subgroups of patients with melanoma suggests the need for adjuvant approaches for this disease. Decisions regarding adjuvant therapy for neoplastic diseases represent a balancing of risk of disease
Summary of adjuvant therapy
There remain many unanswered questions regarding the optimal treatment of patients with resected melanoma and the optimal use of these adjuvant therapies available. However, the data with IFN have led to FDA approval of the agent for the adjuvant therapy for patients with intermediate- or high-risk melanoma, and it has now gained acceptance as a standard agent for patients with melanoma larger than 4 mm or with LN involvement. The 2009 National Comprehensive Cancer Network (NCCN) guidelines
Therapy for metastatic melanoma
The treatment of metastatic melanoma remains a challenge for the clinician. Although the goal of early systemic adjuvant therapy for melanoma has been a central focus in the systemic management of the disease, there remains a high rate of recurrence. The poor outcomes associated with standard cytotoxic chemotherapeutic agents have led to development of numerous alternative therapies for melanoma treatment, particularly the use of immunotherapeutic treatments. An understanding of tumor biology
Summary of therapy for metastatic melanoma
The optimal management of patients with metastatic melanoma is still being defined. Treatments to date have been unsatisfactory, with median survival in most studies ranging from 6 to 9 months and 5-year survival rates of 1% to 2%.69 In formulating a treatment plan, patients must be assessed for the relative volume and pace of disease, the presence of brain metastases, and the performance status, as each of these may impact decisions on care. Predictors of poor prognosis include decreased
Summary
The medical therapy for melanoma is evolving. The vast knowledge base that is being developed regarding the biology of melanoma is leading to the development of multiple new agents, as well as new strategies for use of existing agents for treatment. The understanding of immune function is providing ways to manipulate and modulate the host response to the tumor either through immunomodulatory agents or cellular therapy. Vaccination strategies to treat or even prevent the disease are still an
Acknowledgments
The authors thank Ellie Lehmann for reference management.
References (157)
- et al.
Adjuvant low-dose interferon 2a with or without dacarbazine compared with surgery alone: a prospective -randomized phase III DeCOG trial in melanoma patients with regional lymph node metastasis
Ann Oncol
(2008) - et al.
BCG immunotherapy as a systemic adjunct to surgery in malignant melanoma
Med Clin North Am
(1976) - et al.
Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomized phase III trial
Lancet
(2008) - et al.
Treatment of metastatic melanoma with combined chemotherapy containing cisplatin, vinblastine and dacarbazine (CVD) and biotherapy using interleukin-2 and interferon-alpha
Ann Oncol
(1996) Adjuvant therapy of cutaneous melanoma: the interferon debate
Ann Oncol
(2003)- et al.
Metastatic melanoma: chemotherapy
Semin Oncol
(2002) - et al.
Temozolomide plus pegylated interferon alfa-2b as first-line treatment for stage IV melanoma: a multicenter phase II trial of the Dermatologic Cooperative Oncology Group (DeCOG)
Ann Oncol
(2008) - et al.
Cancer statistics
CA Cancer J Clin
(2008) - et al.
The National Cancer Data Base report on cutaneous and noncutaneous melanoma
Cancer
(2000) - et al.
New TNM melanoma staging system: linking biology and natural history to clinical outcomes
Semin Surg Oncol
(2003)