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Systemic Therapy in Melanoma

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Skin Cancer

Part of the book series: Current Clinical Pathology ((CCPATH))

Abstract

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.

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Authors and Affiliations

  1. Division of Medical Oncology “A”, Medical Oncology Department, National Cancer Institute Regina Elena, Via Elio Chianesi, 53, Rome, 00144, Italy

    Carmen Nuzzo, Maria Simona Pino & Francesco Cognetti MD

Authors
  1. Carmen Nuzzo
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  2. Maria Simona Pino
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  3. Francesco Cognetti MD
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Correspondence to Francesco Cognetti MD .

Editor information

Editors and Affiliations

  1. and Pharmaceutical Sciences and Technologies, Second University of Naples Department of Environmental, Biological, Naples, Italy

    Alfonso Baldi

  2. Department of Dermatology, Pius Hospital de Valls, Valls, Tarragona, Spain

    Paola Pasquali

  3. S.A.F.U. Department, Regina Elena Cancer Institute, Rome, Italy

    Enrico P Spugnini

Glossary

Adjuvant therapy

is a treatment that is given in addition to the primary, main or initial treatment.

BRAF

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.

Interferon-alpha

is a pleiotropic cytokine belonging to type I IFN, currently used in cancer patients.

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Nuzzo, C., Pino, M.S., Cognetti, F. (2014). Systemic Therapy in Melanoma. In: Baldi, A., Pasquali, P., Spugnini, E. (eds) Skin Cancer. Current Clinical Pathology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7357-2_30

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