Elsevier

Seminars in Oncology

Volume 29, Issue 5, October 2002, Pages 413-426
Seminars in Oncology

Systemic chemotherapy for the treatment of metastatic melanoma*

https://doi.org/10.1053/sonc.2002.35237Get rights and content

Abstract

The role of systemic chemotherapy in the treatment of patients with metastatic melanoma remains of questionable benefit. Despite encouraging phase II data from multiple institutions that suggested an improved overall response rate for patients treated with the Dartmouth regimen, recently completed phase III trials have failed to demonstrate a significant benefit in survival. Of concern is the fact that there have been relatively few new chemotherapeutic agents in the past several years that have demonstrated any activity in this disease. More recently there has been a shift away from combination chemotherapy to biochemotherapy. However, this approach has yet to be clearly defined as superior. The basis for optimism in the future in this field resides in the realm of molecular oncology. As mechanisms of resistance are identified, new molecules such as antisense oligonucleotides may provide the basis for increasing the sensitivity of melanoma to chemotherapeutic and/or immunotherapeutic treatments. Semin Oncol 29:413-426. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Dacarbazine

As stated 5 years ago in our last review of this topic, nothing provides a better description of our frustration in treating patients with metastatic melanoma than recognizing that, after more than 30 years, we are still comparing new regimens to the effectiveness of single-agent DTIC.1 The use of DTIC, as a single agent, is associated with an overall response rate in the range of 20% and it can be given in 1-, 3-, 5-, and 10-day regimens.2 Although it is generally accepted that these schedules

Combination chemotherapy

The role of combination chemotherapy in the treatment of metastatic melanoma remains uncertain. Historically, there have been suggestions of improved activity with combination regimens but reports of high response rates have generally emerged from single-institution studies. Large multicenter trials have not confirmed this improvement in response rates.

Conclusion

The treatment of patients with metastatic melanoma remains an enormous challenge. Despite the modest progress that has been made in managing disseminated disease, we still are unable to cure or consistently prolong survival in patients with this disease. Therefore, the treatment of patients with metastatic melanoma must be individualized, considering multiple factors and assessing the patient's overall prognosis.

A variety of biochemotherapy regimens have been studied that appear to be

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    *

    Address reprint requests to Edward F. Mc Clay, MD, San Diego Melanoma Research Center, 910 Sycamore Ave, Suite 102, Vista, CA 92083.

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    Copyright © 2002 Elsevier Science (USA). Published by Elsevier Inc. All rights reserved.