In 2001, the American Joint Committee on
Cancer Melanoma Staging Committee proposed and created a new staging system for
melanoma. This new system will become official in 2002, with the publication of the sixth edition of the AJCC
Cancer Staging Manual. The new system identifies significant prognostic variables in patients with
melanoma and validates them in an analysis of 17,600 patients, making it possible to precisely determine the patient's chance for survival In light of physicians' ability to determine with more precision which patients are at high risk for
melanoma recurrence, they face the dilemma of which, if any, surgical adjuvant
therapy to choose.
Alpha-interferon is the only agent approved for adjuvant
therapy of
melanoma in the United States, but its questionable benefits and substantial side effects make it hard to justify recommending it to patients. Discussion of trials of high- and low-dose
interferon is presented here. The author's group has conducted trials of
granulocyte-macrophage colony-stimulating factor (
GM-CSF [
Leukine]) as surgical adjuvant treatment of patients at high-risk for
melanoma recurrence. One of the most important activities of
GM-CSF is its ability to activate macrophages and cause them to become cytotoxic for human
melanoma cells, at doses low enough to avoid the toxicity associated with other
cytokines. The author presents promising trial results, discusses
GM-CSF in other
malignancies, and includes discussion of
tumor vaccines, biochemotherapy, and other agents being studied as adjuvant
therapy of
melanoma. It is hoped that these newer approaches will result in
therapies that are more effective and less toxic than
interferon.