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Systemic treatments for advanced cutaneous melanoma
C M Anderson1, A C Buzaid, S S Legha
1Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Oncology (Williston Park, N.Y.)
|November 1, 1995
Summary
Treatments for advanced cutaneous melanoma show limited success. Combination therapies, including cisplatin with interferon-alfa and interleukin-2, offer higher response rates but severe toxicity, with survival impact pending.
Area of Science:
- Oncology
- Dermatology
- Medical Research
Background:
- Advanced cutaneous melanoma treatment outcomes are currently unsatisfactory.
- Standard cytotoxic chemotherapy offers limited efficacy, with response rates below 20%.
Purpose of the Study:
- To review current treatment strategies for advanced cutaneous melanoma.
- To evaluate the efficacy and toxicity of various therapeutic regimens.
Main Methods:
- Literature review of single-agent cytotoxic drugs, combination chemotherapy, and immunotherapy (interferon-alfa, interleukin-2).
- Assessment of newer agents like fotemustine and temozolomide, particularly for brain metastases.
- Evaluation of vaccine and monoclonal antibody therapies in advanced and adjuvant settings.
Main Results:
- Single-agent chemotherapy yields <20% response rates; newer agents show promise.
- Combination chemotherapy achieves 20-40% response rates, with rare durable remissions.
- Immunotherapies (IFN-alfa, IL-2) alone have 10-20% response rates, with few durable responses.
- Cisplatin-based regimens plus IFN-alfa and IL-2 show 50-60% overall response rates and 20% complete responses, with severe toxicity.
Conclusions:
- Combination therapies, especially cisplatin with immunotherapy, improve response rates in advanced melanoma.
- High toxicity necessitates careful consideration of these aggressive regimens.
- Further studies are required to establish the survival benefit of these intensive treatments.