Melanoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Chemotherapy is indicated for high risk melanomas (stages > IIA) 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. Chemotherapy, however, is indicated for the following patient subgroups:

• Patients with high risk melanomas (Stage IIB-IV) - Adjuvant therapy using interferon therapy
• Patients with metastatic disease - First-line therapy using either a single agent or combination regimen.

• 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. Below is a summary of available adjuvant and treatment regimens.

Chemotherapy regimens

Adjuvant therapy

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

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

• Single Agent Chemotherapy

1. Dabrafenib (Tafinlar)
2. Dacarbazine (DTIC)
3. Docetaxel (Taxotere)
4. Interleukin-2 (high dose or maintenance biotherapy)
5. Imatinib (Gleevec)
6. Ipilimumab (Yervoy)
7. Nivolumab (Opdivo)
8. Paclitaxel (Taxol)
9. Pembrolizumab (Keytruda)
10. Temozolomide (Temodar)
11. Trametinib (Mekinist)
12. Vemurafenib (Zelboraf)

• Combination Chemotherapy

1. Paclitaxel nanoparticle albumin-bound + Bevacizumab + Carboplatin (ABC)
2. Carboplatin + Paclitaxel
3. Carboplatin + Paclitaxel + nanoparticle albumin-bound
4. Carboplatin + Paclitaxel +, Sorafenib
5. Cisplatin + Dacarbazine ± Carmustine
6. Cisplatin + Dacarbazine + IL-2 + IFN alfa-2b ± Carmustine
7. Cisplatin + Paclitaxel + Dacarbazine
8. Cisplatin + Vinblastine + Dacarbazine
9. Cisplatin + Vinblastine + Dacarbazine + IL-2 + IFN alfa-2b (sequential biochemotherapy)
10. Temozolomide + Bevacizumab
11. Dabrafenib + Trametinib
12. Ipilimumab + Dacarbazine
13. Ipilimumab + Nivolumab