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. 2011;16(1):5-24.
doi: 10.1634/theoncologist.2010-0190. Epub 2011 Jan 6.

Systematic review of medical treatment in melanoma: current status and future prospects

Claus Garbe  1 , Thomas K Eigentler, Ulrich Keilholz, Axel Hauschild, John M Kirkwood
Affiliations

Systematic review of medical treatment in melanoma: current status and future prospects

Claus Garbe et al. Oncologist. 2011.

Abstract

The incidence of melanoma is increasing worldwide, and the prognosis for patients with high-risk or advanced metastatic melanoma remains poor despite advances in the field. Standard treatment for patients with thick (≥2.0 mm) primary melanoma with or without regional metastases to lymph nodes is surgery followed by adjuvant therapy or clinical trial enrollment. Adjuvant therapy with interferon-α and cancer vaccines is discussed in detail. Patients who progress to stage IV metastatic melanoma have a median survival of ≤1 year. Standard treatment with chemotherapy yields low response rates, of which few are durable. Cytokine therapy with IL-2 achieves durable benefits in a greater fraction, but it is accompanied by severe toxicities that require the patient to be hospitalized for support during treatment. A systematic literature review of treatments for advanced, metastatic disease was conducted to present the success of current treatments and the promise of those still in clinical development that may yield incremental improvements in the treatment of advanced, metastatic melanoma.

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Conflict of interest statement

Disclosures: Claus Garbe: Consultant/advisory role: Roche Pharma, MSD, Bristol-Myers Squibb, Swedish Orphan, Genta, GlaxoSmithKline; Research funding/contracted research: Roche Pharma, MSD, Bristol-Myers Squibb, Swedish Orphan, Genta, GlaxoSmithKline; Thomas K. Eigentler: None; Ulrich Keilholz: None; Axel Hauschild: Consultant/advisory role: Abraxis Oncology, Bayer Schering, Bristol-Myers Squibb, Essex Pharma/Schering-Plough; Honoraria: GlaxoSmithKline, Merck, Onyx Pharmaceuticals, Pfizer, Roche Pharma, Synta Pharmaceuticals Corp.; John M. Kirkwood: Consultant/advisory role: Schering (for FDA review of PegIFN), GlaxoSmithKline (for chairmanship of vaccine steering committee).

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Figures

Figure 1.
Figure 1.
Forest plot of disease-free survival of patients with high-risk melanoma treated with various doses of IFN-α adjuvant therapy. Disease-free survival among patients with high-risk melanoma was improved with IFN-α adjuvant therapy compared to control (p < .0001; odds ratio = 0.83; 95% CI = 0.75–0.92). Treatment improved disease-free survival compared with control regardless of dose or pegylation of the adjuvant IFN. Data analysis was performed using the program RevMan (The Cochrane Collaboration). Abbreviations: CI, confidence interval; IFN-α, interferon-α; N, total number of patients per group; n, number of patients with disease progression.
Figure 2.
Figure 2.
Forest plot of overall survival in high risk patients treated with adjuvant interferon-α (IFN-α). Overall survival among patients with high-risk melanoma was improved with IFN-α adjuvant therapy compared to control (p < 0.03; odds ratio = 0.88; 95% CI = 0.79–0.99). Treatment improved overall survival compared with control regardless of dose or pegylation of the adjuvant IFN. Abbreviations: CI, confidence interval; N, total number of patients per group; n, number of patients with disease progression.
Figure 3.
Figure 3.
Overall survival of patients treated with different therapies for melanoma. The data analyzed are listed in Table 1. On this figure, the error bars represent the 95% confidence interval. Abbreviation: DTIC, dacarbazine.
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