[Chemotherapy of malignant melanoma--current status]

Curative treatment modalities for patients with malignant melanoma (MM) in advanced stages are limited. Temporary successes with chemotherapy have so far mainly been achieved after removal of all accessible tumor masses. Extensive experience with cytostatic measures has been gained over more than two decades both with therapeutic and with adjuvant schedules. Dacarbazine (DTIC), which is associated with a remission rate of approximately 20%, continues to be the most effective cytostatic drug in the treatment of MM. Systemic (poly) chemotherapeutic schedules with and without DTIC have improved the response rates in metastasizing MM in numerous phase II trials. However, these results have not been confirmed in randomized studies comparing these schedules with DTIC monochemotherapy. For the BOLD schedule (bleomycin, Oncovin, lomustine, dacarbazine), the BELD schedule (Eldisine instead of Oncovin), and the DVP combination (dacarbazine, vindesine, Platinex), initial response rates of 40-49% have been reported. However, lower response rates were recently described (DVP: 24%; BOLD: 22% and 4%). Therefore, there is still no definite evidence that polychemotherapy is superior to DTIC monotherapy in MM. In our opinion, expected response rates of 20-30% justify the use of chemotherapy in disseminated MM; in cases of further progression, therapy should be interrupted early - after 2-3 cycles. Systemic (poly) chemotherapy of metastasizing MM is indicated in patients whose general condition is good, mainly in those who have skin, soft tissue, or lung metastases. These metastases usually respond well to cytostatic treatment. In future, the combined use of cytostatics together with new antitumour molecules may reduce the general toxicity and improve the efficacy of systemic cytostatic therapy in MM. The benefits of adjuvant chemotherapy in the treatment of MM have still to be confirmed definitively. While adjuvant therapy with DTIC has proved to be ineffective in stage I, irrespective of the tumor thickness, some studies suggest that adjuvant therapy with DTIC, or combinations including DTIC, may improve the prognosis of patients in clinical stage II.