Adjuvant therapy of melanoma Journal Article
| Authors: | Shah, G. D.; Chapman, P. B. |
| Article Title: | Adjuvant therapy of melanoma |
| Abstract: | Purpose:: The purpose of this article was to review the current state of knowledge regarding the efficacy of adjuvant therapy for melanoma. Patients and methods:: We reviewed the published literature, focusing on randomized clinical trials. Results:: There have been no meaningful trials addressing adjuvant chemotherapy in melanoma because all trials have been underpowered. Adjuvant interferon-α has been tested both at high dose and at lower doses. None of the trials have shown a reproducible benefit in survival, although the high-dose trials and some of the low-dose trials have shown improvement in time to relapse. These experiences raise the question of whether chronic administration is more important than dose. An adjuvant pegylated interferon- α trial using a 5-year treatment period is currently under investigation. At least 7 randomized adjuvant vaccine trials have been published, but none have shown a beneficial effect on relapse-free or overall survival except in subset analyses. Conclusions:: To date, no adjuvant therapy has resulted in improved overall survival. To be attractive as an adjuvant therapy, experience from other tumor types indicates that a chemotherapy regimen should have a response rate of at least 20% in metastatic melanoma. Currently, biochemotherapy is being tested as an adjuvant treatment but other, less toxic, regimens should be sought. Once such a regimen with acceptable toxicity is identified, it would be reasonable to test it as an adjuvant therapy in a properly powered randomized trial. High-dose interferon- α for 1 year remains the only U.S. Food and Drug Administrationĝ€"approved adjuvant therapy for melanoma, but long-term chronic dosing of interferon-α may prove more effective than short-term dose schedules. Development of melanoma vaccines remains an appealing and important goal. New technologies and understanding of the immune response against melanoma are leading to novel vaccine strategies designed to break immunologic tolerance against melanoma. © 2007 Lippincott Williams & Wilkins. |
| Keywords: | survival; cancer chemotherapy; cancer survival; survival analysis; cancer surgery; overall survival; clinical trial; mortality; review; angiogenesis inhibitor; drug withdrawal; united states; alpha interferon; cancer adjuvant therapy; chemotherapy, adjuvant; methodology; lymph node metastasis; t lymphocyte; bcg vaccine; dacarbazine; interleukin 2; melanoma; metastasis; randomized controlled trial; randomized controlled trials as topic; food and drug administration; time; monoclonal antibody; immunological tolerance; immunology; immune response; immunotherapy; cancer vaccine; cancer vaccines; adjuvant chemotherapy; cancer relapse; medical literature; therapy effect; melacine; cytotoxic t lymphocyte antigen 4; drug substitution; angiogenesis inhibitors; randomized trial; ganglioside gm2; technology; vaccine; interferon-alpha; keyhole limpet hemocyanin; knowledge; plasmid dna; qs 21; melanoma vaccine; peginterferon alpha; interferon- |
| Journal Title: | The Cancer Journal |
| Volume: | 13 |
| Issue: | 3 |
| ISSN: | 1528-9117 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2007-05-01 |
| Start Page: | 217 |
| End Page: | 222 |
| Language: | English |
| DOI: | 10.1097/PPO.0b013e318074dfd4 |
| PUBMED: | 17620773 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 14" - "Export Date: 17 November 2011" - "CODEN: CAJOC" - "Source: Scopus" |
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