In a nutshell
The authors aimed to compile a review of current and emerging melanoma treatments.
Some background
The occurrence of cutaneous melanoma (melanoma of the skin) is increasing across the world with 160,000 new cases and 48,000 deaths occurring globally per year. UV ray exposure is one of the most common causes of melanoma and can result from increased sun exposure or sunbed use. Melanoma can also develop due to family genetics where mutations in specific genes can be passed on to family members.
Treatments such as surgery, systemic adjuvent therapy (further treatment given following primary treatment) and immunomodulation (treatment given to increase the bodies immune response to disease) have been used to treat various stages of cutaneous melanoma. This includes stage II (tumor thickness of between 1 and 4 millimeters), stage III (tumor can be any thickness and has spread to the lymph nodes) and stage IV (cancer has spread around the body to other organs) melanoma.
Methods & findings
The aim of this review was to compare results of both current and emerging drugs and their success in treating cutaneous melanoma.
Sentinel-node biopsy (removes tissue from the lymph node [site that holds immune cells] to determine cancer progression) is the standard method used in predicting the outlook of melanoma. However, 5-year survival rates in patients who test positive for cancer in the lymph nodes vary from 64-91% depending on tumor load (number of cancerous cells present). Sentinel-node biopsy does not significantly effect survival in melanoma patients when added to surgical treatment.
Interferon-alfa is the most common systemic adjuvant treatment used in stage IV melanoma though it has a modest success rate. Phase III trials show a positive effect on increasing relapse-free survival (time from treatment until cancer recurrence) but little effect on overall survival (time from treatment until death by any cause).
In 2011 pegylated interferon alfa-2b (Sylatron) was approved for stage III melanoma treatment. Results comparing interferon alfa-2b (Intron A – common treatment) and pegylated interferon alfa-2b show that patients with stage II ulcerated tumors respond significantly better to both treatments in terms of overall survival, relapse-free survival and distant metastasis-free survival (period of time after treatment where no cancer is detected) compared to patients with stage III non-ulcerated melanoma. The study concluded that ulceration (break in the skin) is a major factor that predicts interferon alfa success.
Stage IV melanoma has a poor survival rate of 6-9 months. Dacarbazine (DTIC) was the only treatment available until the immunomodulation drug (affects the immune system) ipilimumab (Yervoy) was approved in the USA. Ipilimumab provided a 3.6 month survival benefit and a 33% survival benefit compared to vaccinations (eg; interferon alfa) and increased survival benefits of 10% at year 1 and 2 when compared to dacarbazine.
Emerging immunomodulation treatments nivolumab and lambrolizumab have shown response rates in phase I trials far superior to ipilimumab of 30-50% and survival rates of 61% at 1 year and 44% at 2 years with favorable safety profiles when compared to ipililmumab.
The bottom line
The authors conclude that there are numerous emerging treatments that look promising in treating cutaneous melanoma.
The fine print
The data used was obtained from a number of articles where experimental procedures may differ leading to biased result comparisons.
What’s next?
If you are interested in any of the treatments discussed in this article and would like further information on their benefits, please consult your doctor.
