Malignant melanoma: Current therapeutic concepts

Journal/Book: Onkologie 18 (6), 534-547. 1995;

Abstract: The number of therapeutic concepts for treatment of malignant melanomais continuously growing, and new insights into the mechanism oftreatment approaches have been gained. Depending on the clinical stageof the disease local, regional or systemic treatment modalities can beadministered in a curative, adjuvant or palliative setting. The onlypossibility to cure a melanoma is to detect the primary tumor in a veryearly phase of development and immediately remove it. Adjuvant therapyoptions have been followed for years and can be divided into subgroupssuch as historical approaches like BCG (bacille Calmette-Guerin),levamisole, pre- and postoperative radiation of the primary tumor,endolymphatic radionuclid therapy or extended safety margins. 'Standard'therapies have been carried out within study protocols, e.g. electivelymph node dissection or extremity perfusion. Recent strategies such asthe application of cytokines and tumor or antigen vaccines are stillbeing investigated. As none of the results shows a definite advantage ofone or the other kind of treatment, adjuvant therapy should only be donewithin study protocols. Metastatic melanoma remains incurable yet highlytreatable. When critically analyzing the results, certain protocols areregarded as standard therapy for palliative treatment: surgery,radiotherapy, and chemotherapy. Other therapy strategies, some of themhave been used for a long time (e.g. multimodality treatment), mayimprove tumor remission rates and long-term survival, but obviouslyfurther randomized prospective trials are needed. There are even moreexperimental therapy concepts such as stereotactic single high-doseirradiation, photodynamic therapy, the application of a new generationof monoclonal antibodies or gene therapy. Current therapy protocolsemphasize the reduction of toxicity. The question has been raisedwhether the paradigm of tumor killing, as nowadays postulated for curingthe patient, may be counter-productive as it impairs host response.Efforts will have to be made to unravel differences in therapy resultsbetween single institution and multicenter studies and make differentschedules containing the same drugs comparable as well as define thepatient population benefiting from a certain form of therapy. Continuousresearch in molecular biology and tumor immunology has enhanced ourunderstanding of malignant melanoma and may help to develop a morespecific, effective, and less toxic therapy.

Keyword(s): Medical:melanoma /drug therapy

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