Biochemotherapy of melanoma

Based on the observation of a small proportion of long-term responses the use of biotherapy or biochemotherapy is currently preferred in many institutions as first line treatment in stage IV melanoma, but still the outcome for patients with stage IV melanoma is unsatisfactory. Various interleukin 2 (IL-2) dosing schedules and combinations with interferon alpha (IFN-alpha) have been tested in patients with advanced melanoma in phase I and II studies. The response rate reported with cytokines alone (IL-2 as a single agent or in combination with IFN-alpha) varies from 10-41%. Subsequently, biochemotherapy regimens combining IL-2, IFN-alpha and chemotherapy have been evaluated in phase II trials suggesting improved response rates. Recent randomised trials have investigated the role of biochemotherapy as compared to biotherapy alone or as compared to chemotherapy for the treatment of advanced melanoma. So far, none of the approaches has been proven to confer a survival benefit and thus the uniform desire is to include as many patients as possible into controlled clinical trials. Therefore current trials are under way trying to improve the efficacy of immunotherapy alone by adding histamine or vaccines to IL-2.