Systemic Therapy in Melanoma
The incidence of malignant melanoma (MM) is continuously rising, representing today the second most common cancer in women and the third in men younger than 40 years. Excisional surgery represents the primary treatment for MM. Adjuvant treatment for melanoma at high risk of recurrence is still debated. Interferon, observation, and inclusion in clinical trials are all valid options. Although several systematic reviews have shown that in patients at high risk of relapse therapy with INF produces a benefit in terms of disease-free survival (DFS) and overall survival (OS), the inclusion of these patients in clinical trials should be a priority. In the absence of such study protocols, the decision about the appropriateness of administering high-dose INF should be taken on individual basis after discussion of the potential benefits and side effects of the treatment. The prognosis of metastatic melanoma remains poor. Different chemotherapeutic agents, such as dacarbazine, temozolomide, and fotemustine, have shown clinical activity when used as single agent. No combination regimens have shown, in controlled, randomized studies, to hold a significant benefit in survival compared with single agents. More recently new molecules, such as inhibitors of BRAF (PLX4032, GSK2118438), and the anti-CTLA-4 monoclonal antibody, ipilimumab, have shown for the first time in 30 years of clinical trials to increase survival. Numerous other molecules are still under study, but the results are to be confirmed.
KeywordsOverall Survival Metastatic Melanoma Melanoma Patient BRAF Mutation Advanced Melanoma
is a treatment that is given in addition to the primary, main or initial treatment.
is a human gene that makes a protein called B-Raf. The gene is also referred to as proto-oncogene B-Raf and v-Raf murine sarcoma viral oncogene homolog B1, while the protein is more formally known as serine/threonine-protein kinase B-Raf.
is a pleiotropic cytokine belonging to type I IFN, currently used in cancer patients.
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