Metastatic melanoma: chemotherapy to biochemotherapy

Background Single-agent or combination chemotherapy regimens have not impacted the short median survival of patients with metastatic melanoma, and complete or durable responses are rare. Biologic response modifiers (interferon and interleukin-2) have produced durable remissions in a small cohort of patients, and phase II trials of biochemotherapy suggest more benefit. Methods The authors retrospectively reviewed the status of the current treatments of metastatic melanoma focusing on biochemotherapy. Results Regimens include both sequential and concurrent approaches for inpatient and outpatient treatment settings. Overall response rates in phase II trials are 40% to 60% with complete responses of 10% to 20% and median survivals in the 11- to 12-month range. Modifications of concurrent biochemotherapy regimens have maintained efficacy and reduced toxicity. Small phase III trials suggest a survival advantage of biochemotherapy (P=.05). Conclusions Biochemotherapy remains a promising new treatment for metastatic melanoma. A large Intergroup trial E3695 comparing concurrent biochemotherapy to combination chemotherapy alone is powered to answer important survival questions.