Metastatic Melanoma Treatment: A Poor Prognosis

Despite significant advances in cancer treatment, the 5-year survival rate for patients with distant metastases of melanoma remains less than 10%. Patients with advanced melanoma often receive systemic therapy, with single-agent cytotoxic chemotherapy using dacarbazine as the standard of care in community practice. However, the response rate is generally low, and few patients attain complete remission. Researchers at the University of Texas recommend new strategies to improve treatment response rates and duration of overall survival for patients with metastatic melanoma.

Key Takeaways:

The 5-year survival rate for patients with distant metastases of melanoma is less than 10%.
Single-agent cytotoxic chemotherapy with dacarbazine is the standard of care in community practice, but the response rate is generally low.
Temozolomide, an orally active congener of dacarbazine, is at least as effective as dacarbazine when used as single-agent cytotoxic therapy.
Low-dose extended temozolomide regimens may provide greater antitumor efficacy.
Combinations of dacarbazine or temozolomide with other cytotoxic therapies have not markedly improved patient survival.
Newer agents, such as lomeguatrib and decitabine, have been developed to overcome mechanisms of drug resistance.
Biotherapy using high-dose interleukin-2 has been shown to induce durable responses lasting 5 years or more in some patients.
Interferon a is also used for the treatment of metastatic melanoma, despite lack of FDA approval for this indication.
Combining chemotherapy and biotherapy agents (biochemotherapy) increases the rate of treatment response but does not significantly extend overall survival.

Statistics:

5-year survival rate for patients with distant metastases of melanoma: less than 10%
Response rate to chemotherapy with dacarbazine: generally low
Antitumor efficacy of low-dose extended temozolomide regimens: greater
Overall survival benefit of biochemotherapy: none

Sources:

Trinh, V.A., et al. "Current management of metastatic melanoma." American Journal of Health - System Pharmacy, 2008;65(24 Suppl.): S3-S9.
American Society Health-System Pharmacists. Publisher contact information: 7272 Wisconsin Avenue, Bethesda, MD 20814, USA.
University of Texas MD Anderson Cancer Center. Contact information: 1515 Holcombe Blvd., Box 0377, Houston, TX 77030, USA.