Metastatic melanoma—challenges for the community oncologist!! Jim Breitfeller

Michael B. Atkins, MD | Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

"The outlook for patients with advanced
melanoma is bleak. Patients with stage IV melanoma have a median
survival of 6–9 months,1–3 with 5-year survival rates of 1%–2%.1,4

An estimated 8,000 Americans will die of melanoma in 2008.1,5 Many of these patients are young, with a median age of ~ 50 years, and otherwise healthy.1,5 This loss of life represents a societal burden in excess
of the actual numbers. Although melanoma is the ninth most common cancer in the United States,1,6 it ranks second among solid tumors in terms of years of productive life lost.

Common treatment approaches have included:
cytotoxic chemotherapy; interleukin-2 (IL-2)–based immunotherapy; and combinations of chemotherapy and immunotherapy (so-called biochemotherapy). Although some treatment approaches, most notably, high-dose IL-2 immunotherapy,
have been shown to produce extremely durable tumor responses in a small percentage of patients,4,7,8 no treatment approach has shown a reproducible survival advantage in phase III trials.

There is a critical need for new treatment approaches for patients with advanced melanoma.Recent advances in the understanding of melanoma
biology, immune regulation, and tumor-induced immune suppression are the foundation for new opportunities to improve therapeutic outcomes for patients with advanced melanoma. Studies of melanoma biology have uncovered critical factors that are important for melanoma cell survival, including activating mutations in BRAF, which occur in > 50% of melanomas; mutations in KIT, the gene encoding the c-Kit receptor, which are common in acral lentiginous and mucosal primary melanomas; overexpression of vascular endothelial growth factor, which drives tumor angiogenesis; and an assortment of factors that limit the apoptotic effects of various cytotoxic chemotherapy agents."

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http://www.oncologystat.com/Images/metastatic_melanoma_tcm8-162554.pdf
Metastatic melanoma—challenges for the community oncologist



Jimmy B