Treatment of Metastatic Melanoma: An Overview

ABSTRACT: The 10-year survival rate for patients with metastatic melanoma is less than 10%. Although surgery and radiation therapy have a role in the treatment of metastatic disease, systemic therapy is the mainstay of treatment for most patients. Single-agent chemotherapy is well tolerated but is associated with response rates of only 5% to 20%. Combination chemotherapy and biochemotherapy may improve objective response rates but do not extend survival and are associated with greater toxicity. Immunotherapeutic approaches such as high-dose interleukin-2 are associated with durable responses in a small percentage of patients. In this article, we review the treatments for metastatic melanoma including promising investigational approaches.

Metastatic melanoma continues to be a challenging disease to treat, with an estimated 8,420 related deaths in the United States in 2008.[1] The 10- year survival rate for patients with metastatic melanoma is less than 10%.[2] More than 3 decades after its initial approval by the US Food and Drug Administration (FDA) in 1975, dacarbazine continues to be the standard of care for most patients with this disease. High-dose interleukin-2 (HD IL-2 [Proleukin]), approved by the FDA in 1998 for metastatic melanoma, benefits a small subset of patients. Attempts to improve upon the survival of patients with metastatic disease have met with failure, and the need for successful new therapies for metastatic melanoma cannot be overemphasized. However, our understanding of the biology of this disease is steadily increasing, and many promising therapeutic approaches are currently under investigation. We discuss the various systemic therapeutic approaches to the treatment of metastatic melanoma below.

Prognostic Factors for Metastatic Melanoma

TABLE 1

Subcategories of Metastatic Disease, as Defined in the 2002 AJCC Staging System for Cutaneous Melanoma, and Survival Rates

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