The treatment of metastatic melanoma with chemotherapy and biologics.

Metastatic malignant melanoma remains a frustrating and almost invariably fatal disease. Nonetheless, both cytotoxic chemotherapy and immunotherapy agents have shown activity against this disease, and an occasional patient will experience long-term benefit from therapy. Regimens involving various combinations of chemotherapy, the addition of either tamoxifen or interferon alfa have shown promise in phase III trials, but as yet no agent has proven to be superior to single agent dacarbazine alone. Immunotherapy with high-dose interleukin-2, has produced durable complete responses in a small percentage of patients, and combinations of cisplatin-based chemotherapy and interleukin-2-based immunotherapy have produced responses in approximately 50% of patients with 10% durable complete responses. These encouraging results have prompted the design and initiation of several phase III trials comparing various combination biochemotherapy regimens to either chemotherapy or immunotherapy alone. Several new cytotoxic and biologic agents including specific vaccines have recently been investigated, which may add to the therapeutic armamentarium. This article reviews the promising new developments in the treatment of metastatic melanoma, and it places them within in the context of established treatment approaches for this disease.