Adjuvant therapy of melanoma

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.