Melanoma medical therapy: Difference between revisions

	Melanoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Melanoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Melanoma medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Melanoma medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Melanoma medical therapy
CDC on Melanoma medical therapy
Melanoma medical therapy in the news
Blogs on Melanoma medical therapy
Directions to Hospitals Treating Melanoma
Risk calculators and risk factors for Melanoma medical therapy

VisualWikitext

Latest revision as of 12:57, 11 July 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.

Overview

Chemotherapy is indicated for high risk melanomas (stages IIB-IV) as adjuvant therapy and for metastatic disease as first-line therapy. Several single agent and combination regimens have been studied, all with modest impact on survival. All current guidelines still recommend enrollment in clinical trials over current available regimens for patients with metastatic disease. Interferon therapy is the only regimen recommended for adjuvant therapy.

Medical Therapy

Surgery is the predominant therapy for melanoma.a

Chemotherapy regimens

Adjuvant therapy^[1]

Interferon alfa-2a (Roferon-A)
Interferon alfa-2b (Intron-A)
Peginterferon alfa-2b (Sylatron)

Metastatic or unresectable melanoma^[1]
Either a single agent chemotherapy OR a combination chemotherapy is recommended for metastatic or unresectable melanoma.

Single Agent Chemotherapy

Dabrafenib (Tafinlar)
Dacarbazine (DTIC)
Docetaxel (Taxotere)
Interleukin-2 (high dose or maintenance biotherapy)
Imatinib (Gleevec)
Ipilimumab (Yervoy)
Nivolumab (Opdivo)
Paclitaxel (Taxol)
Pembrolizumab (Keytruda)
Temozolomide (Temodar)
Trametinib (Mekinist)
Vemurafenib (Zelboraf)

Combination Chemotherapy

Paclitaxel nanoparticle albumin-bound + Bevacizumab + Carboplatin (ABC)
Carboplatin + Paclitaxel
Carboplatin + Paclitaxel + nanoparticle albumin-bound
Carboplatin + Paclitaxel +, Sorafenib
Cisplatin + Dacarbazine ± Carmustine
Cisplatin + Dacarbazine + IL-2 + IFN alfa-2b ± Carmustine
Cisplatin + Paclitaxel + Dacarbazine
Cisplatin + Vinblastine + Dacarbazine
Cisplatin + Vinblastine + Dacarbazine + IL-2 + IFN alfa-2b (sequential biochemotherapy)
Temozolomide + Bevacizumab
Dabrafenib + Trametinib
Ipilimumab + Dacarbazine
Ipilimumab + Nivolumab
Binimetinib + Encorafenib

References

↑ ^1.0 ^1.1 Peter Yang and Jeremy Warner. Melanoma. Hemonc.org. Accessed on August 21, 2015. http://hemonc.org/wiki/Melanoma

[hemonc-1] 1.0 ^1.1 Peter Yang and Jeremy Warner. Melanoma. Hemonc.org. Accessed on August 21, 2015. http://hemonc.org/wiki/Melanoma

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}
+{{CMG}} {{AE}} {{SSK}}; {{YD}}
 {{Melanoma}}
 ==Overview==
+Chemotherapy is indicated for high risk melanomas (stages IIB-IV) as adjuvant therapy and for metastatic disease as first-line therapy. Several single agent and combination regimens have been studied, all with modest impact on survival. All current guidelines still recommend enrollment in clinical trials over current available regimens for patients with metastatic disease. Interferon therapy is the only regimen recommended for adjuvant therapy.
-==Treatment methods==
+==Medical Therapy==
-===Adjuvant treatment===
+*Surgery is the predominant therapy for melanoma.a
-High risk melanomas may require referral to a medical or surgical oncologist for adjuvant treatment. In the United States most patients in otherwise good health will begin up to a year of high-dose [[interferon]] treatment, which has severe side effects, but may improve the patients' prognosis.<ref>{{cite journal | author = Kirkwood J, Strawderman M, Ernstoff M, Smith T, Borden E, Blum R | title = Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. | journal = J Clin Oncol | volume = 14 | issue = 1 | pages = 7-17 | year = 1996 | id = PMID 8558223}}</ref> This claim is not supported by all research at this time and in Europe interferon is usually not used outside the scope of clinical trials.<ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Richards J, Flaherty L, Ernstoff M, Smith T, Rao U, Steele M, Blum R | title = High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. | journal = J Clin Oncol | volume = 18 | issue = 12 | pages = 2444-58 | year = 2000 | id = PMID 10856105}}</ref><ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Ernstoff M, Ross M | title = Interferon alfa-2a for melanoma metastases. | journal = Lancet | volume = 359 | issue = 9310 | pages = 978-9 | year = 2002 | id = PMID 11918944}}</ref>
-Metastatic melanomas can be detected by X-rays, CT scans, MRIs, PET and PET/CTs, ultrasound, LDH testing and photoacoustic detection.<ref>{{cite journal | author =  Weight RM, Viator JA, Dale PS, Caldwell CW, Lisle AE. | title = Photoacoustic detection of metastatic melanoma cells in the human circulatory system. | journal = Opt Lett.| volume = 31 | issue = 20 | pages = 2998-3000 | year = 2006 | id = PMID 17001379}}</ref>
+===Chemotherapy regimens===
+'''Adjuvant therapy'''<ref name=hemonc>Peter Yang and Jeremy Warner. Melanoma. Hemonc.org. Accessed on August 21, 2015. http://hemonc.org/wiki/Melanoma</ref>
+# [[Interferon-alpha|Interferon alfa-2a]] (Roferon-A)
+# [[Interferon-alpha|Interferon alfa-2b]] (Intron-A)
+# [[Interferon-alpha|Peginterferon alfa-2b]] (Sylatron)
-====Chemotherapy and immunotherapy====
+'''Metastatic or unresectable melanoma'''<ref name=hemonc>Peter Yang and Jeremy Warner. Melanoma. Hemonc.org. Accessed on August 21, 2015. http://hemonc.org/wiki/Melanoma</ref>
-Various [[chemotherapy]] agents are used, including [[dacarbazine]] (also termed DTIC), [[Cancer immunotherapy|immunotherapy]] (with [[interleukin-2]] (IL-2) or [[interferon]] (IFN)) as well as local perfusion are used by different centers. They can occasionally show dramatic success, but the overall success in metastatic melanoma is quite limited.<ref>{{cite journal | author = Bajetta E, Del Vecchio M, Bernard-Marty C, Vitali M, Buzzoni R, Rixe O, Nova P, Aglione S, Taillibert S, Khayat D | title = Metastatic melanoma: chemotherapy. | journal = Semin Oncol | volume = 29 | issue = 5 | pages = 427-45 | year = 2002 | id = PMID 12407508}}</ref> IL-2 (Proleukin®) is the first new therapy approved for the treatment of metastatic melanoma in 20 years. Studies have demonstrated that IL-2 offers the possibility of a complete and long-lasting remission in this disease, although only in a small percentage of patients.<ref>{{cite journal | author = Buzaid A | title = Management of metastatic cutaneous melanoma. | journal = Oncology (Williston Park) | volume = 18 | issue = 11 | pages = 1443-50; discussion 1457-9 | year = 2004 | id = PMID 15609471}}</ref> A number of new agents and novel approaches are under evaluation and show
+<br>Either a single agent chemotherapy {{or}} a combination chemotherapy is recommended for metastatic or unresectable melanoma.
-promise.<ref>{{cite journal | author = Danson S, Lorigan P | title = Improving outcomes in advanced malignant melanoma: update on systemic therapy. | journal = Drugs | volume = 65 | issue = 6 | pages = 733-43 | year = 2005 | id = PMID 15819587}}</ref>
+:* ''Single Agent Chemotherapy''
+::# [[Dabrafenib]] (Tafinlar)
+::# [[Dacarbazine]] (DTIC)
+::# [[Docetaxel]] (Taxotere)
+::# [[Interleukin-2]] (high dose or maintenance biotherapy)
+::# [[Imatinib]] (Gleevec)
+::# [[Ipilimumab]] (Yervoy)
+::# [[Nivolumab]] (Opdivo)
+::# [[Paclitaxel]] (Taxol)
+::# [[Pembrolizumab]] (Keytruda)
+::# [[Temozolomide]] (Temodar)
+::# [[Trametinib]] (Mekinist)
+::# [[Vemurafenib]] (Zelboraf)
-===Lentigo maligna treatment===
+:* ''Combination Chemotherapy''
-Some superficial melanomas (lentigo maligna) have resolved with an experimental treatment,  [[imiquimod]] (Aldara®) topical cream, an immune enhancing agent.  Application of this cream has been shown to decrease tumor size prior to surgery, reducing the invasiveness of the procedure.  This treatment is used especially for smaller melanoma in situ lesions located in cosmetically sensitive regions.  Several published studies demonstrate a 70% cure rate with this topical treatment.  With lentigo maligna, surgical cure rates are no higher. Some dermasurgeons are combining the 2 methods: surgically excise the cancer, then treat the area with Aldara® cream post-operatively for 3 months.
+::# [[Paclitaxel]] nanoparticle albumin-bound + Bevacizumab + Carboplatin (ABC)
+::# [[Carboplatin]] + [[Paclitaxel]]
-===Radiation and other therapies===
+::# [[Carboplatin]] + [[Paclitaxel]] + nanoparticle albumin-bound
-[[Radiation therapy]] is often used after surgical resection for patients with locally or regionally advanced melanoma or for patients with unresectable distant metastases. It may reduce the rate of local recurrence but does not prolong survival.<ref>{{cite journal | author = Bastiaannet E, Beukema J, Hoekstra H | title = Radiation therapy following lymph node dissection in melanoma patients: treatment, outcome and complications. | journal = Cancer Treat Rev | volume = 31 | issue = 1 | pages = 18-26 | year = 2005 | id = PMID 15707701}}</ref>
+::# [[Carboplatin]] + [[Paclitaxel]] +, [[Sorafenib]]
+::# [[Cisplatin]] + [[Dacarbazine]] ± [[Carmustine]]
-In research setting other therapies, such as [[gene therapy]], may be tested.<ref>{{cite journal | author = Sotomayor M, Yu H, Antonia S, Sotomayor E, Pardoll D | title = Advances in gene therapy for malignant melanoma. | journal = Cancer Control | volume = 9 | issue = 1 | pages = 39-48 | year = | id = PMID 11907465}}''[https://www.moffitt.usf.edu/pubs/ccj/v9n1/pdf/39.pdf Full text (PDF)]''</ref> [[Radioimmunotherapy]] of metastatic melanoma is currently under investigation.
+::# [[Cisplatin]] + [[Dacarbazine]] + [[IL-2]] + [[Interferon-alpha|IFN alfa-2b]] ± [[Carmustine]]
-<p>Experimental treatment developed at the National Cancer Institute (NCI), part of the National Institutes of Health in the US was used in advanced (metastatic) melanoma with moderate success.
+::# [[Cisplatin]] + [[Paclitaxel]] + [[Dacarbazine]]
-The treatment, adoptive transfer of genetically altered autologous lymphocytes,
+::# [[Cisplatin]] + [[Vinblastine]] + [[Dacarbazine]]
-depends on delivering genes that encode so called T cell receptors (TCRs), into patient's lymphocytes. After that manipulation lymphocytes recognize and bind to certain molecules found on the surface of melanoma cells and kill them.<ref name="nih">[http://www.nih.gov/news/pr/aug2006/nci-31b.htm Press release from the NIH]</ref>
+::# [[Cisplatin]] + [[Vinblastine]] + [[Dacarbazine]] + [[IL-2]] + [[Interferon-alpha|IFN alfa-2b]] (sequential biochemotherapy)
+::# [[Temozolomide]] + [[Bevacizumab]]
+::# [[Dabrafenib]] + [[Trametinib]]
+::# [[Ipilimumab]] + [[Dacarbazine]]
+::# [[Ipilimumab]] + [[Nivolumab]]
+::# [[Binimetinib]] + [[Encorafenib]]
 ==References==
 {{Reflist|2}}
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Dermatology]]
+[[Category:Surgery]]