Systemic therapy of disseminated malignant melanoma: an evidence-based overview of the state-of-the-art in daily routine.

Abstract

AIMS:

In the metastatic stage, malignant melanoma is resistant to systemic treatment and carries a poor prognosis. A critical, evidence-based analysis of standard approaches based on an extended search of published literature and from different Internet sources is presented.

MATERIAL AND METHODS:

A critical, evidence-based analysis of standard approaches and their variations to systemic therapy based on an extended search of published literature and from different Internet sources is presented. Few meta-analyses are available. Therefore, assessment of therapies is mainly based on randomized multicentre studies or clinical studies achieving an evidence level grade 1 or 2.

RESULTS:

Monotherapy with DTIC (dacarbazine) is the standard. Based on overall survival data, polychemotherapies cannot be recommended. Combination of polychemotherapy with the cytokines interferon-alpha and interleukin-2 substantially augments chemotherapy induced response rates, but a meta-analysis for survival does not support its therapeutic superiority. Biological therapies such as vaccinations have not yet delivered results on a higher evidence level. Thus, immunotherapies as well as chemo-immunotherapies will have to be evaluated in further studies.

CONCLUSIONS:

Although the therapeutic efficacy is very limited, dacarbazine cannot be rejected as standard therapy for disseminated melanoma, because no other therapeutic regimen exhibits a survival benefit over DTIC in an evidence-based analysis. This lack of therapeutic progress over the past 40 years clearly calls for further clinical studies, and patients should be enrolled into clinical trials whenever possible.

• Authors: D Nashan, M L Müller, S Grabbe, S Wustlich, A Enk
• Journal: Journal of the European Academy of Dermatology and Venereology : JEADV (J Eur Acad Dermatol Venereol) Vol. 21 Issue 10 Pg. 1305-18 (Nov 2007) ISSN: 0926-9959 [Print] England
• PMID: 17958834 (Publication Type: Journal Article, Review)

Chemical References

• Antineoplastic Agents, Alkylating
• Cancer Vaccines
• Interferon-alpha
• Interleukin-2
• Dacarbazine

Topics

• Antineoplastic Agents, Alkylating (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cancer Vaccines
• Dacarbazine (therapeutic use)
• Evidence-Based Medicine
• Humans
• Immunotherapy
• Interferon-alpha (therapeutic use)
• Interleukin-2 (therapeutic use)
• Melanoma (drug therapy, pathology)
• Neoplasm Metastasis
• Prognosis