Metastatic melanoma: chemotherapy to biochemotherapy

Abstract

Background: Single-agent or combination chemotherapy regimens have not impacted the short median survival of patients with metastatic melanoma, and complete or durable responses are rare. Biologic response modifiers (interferon and interleukin-2) have produced durable remissions in a small cohort of patients, and phase II trials of biochemotherapy suggest more benefit.

Methods: The authors retrospectively reviewed the status of the current treatments of metastatic melanoma focusing on biochemotherapy.

Results: Regimens include both sequential and concurrent approaches for inpatient and outpatient treatment settings. Overall response rates in phase II trials are 40% to 60% with complete responses of 10% to 20% and median survivals in the 11- to 12-month range. Modifications of concurrent biochemotherapy regimens have maintained efficacy and reduced toxicity. Small phase III trials suggest a survival advantage of biochemotherapy (P=.05).

Conclusions: Biochemotherapy remains a promising new treatment for metastatic melanoma. A large Intergroup trial E3695 comparing concurrent biochemotherapy to combination chemotherapy alone is powered to answer important survival questions.