Advances in systemic treatment of malignant melanoma.

This paper reviews recent developments in the systemic treatment of advanced malignant melanoma. In the introduction emphasis is given to prevention and early detection of this disease. Metastatic malignant melanoma patients have a median survival of less than 1 year in the most favourable situation. Adjuvant chemotherapeutic treatment after initial surgery has not had an impact on prognosis, while immunological manipulations with interferon alfa or other agents may prove beneficial after primary surgery. In advanced disease which cannot be palliated by surgery, many approaches are under investigation. Modulation of the patient's immune response can be achieved with vaccines, monoclonal antibodies, interleukin-2 and interferons, as single agents or in combination between themselves or with peripheral blood mononuclear cells or with tumour infiltrating lymphocytes or even with chemotherapy. Immunological approaches yield a 20-30% response rate, with some possibly long-term responses. Chemotherapeutic agents have a 10-30% response rate, which is usually of short duration. Combinations of chemotherapeutic agents can increase the response rate to 50%, but an impact on ultimate survival seems unlikely. Randomised studies have shown that modulation of chemotherapy with interferon or tamoxifen improves response rates. Clinicians should be encouraged to enter their patients with malignant melanoma in therapeutic trials.