title: Systemic treatments for metastatic cutaneous melanoma.
abstract: BACKGROUND
  Systemic therapies for metastatic cutaneous melanoma, the most aggressive of all skin cancers, remain disappointing. Few lasting remissions are achieved and the therapeutic aim remains one of palliation. Many agents are used alone or in combination with varying degrees of toxicity and cost. It is unclear whether evidence exists to support these complex regimens over best supportive care / placebo.
  
  
  OBJECTIVE
  To review the benefits from the use of systemic therapies in metastatic cutaneous melanoma compared to best supportive care/placebo, and to establish whether a 'standard' therapy exists which is superior to other treatments.
  
  
  METHODS
  Randomised controlled trials were identified from the MEDLINE, EMBASE and CCTR/CENTRAL databases. References, conference proceedings, and Science Citation Index/Scisearch were also used to locate trials. Cancer registries and trialists were also contacted.
  
  
  METHODS
  Randomised controlled trials of adults with histologically proven metastatic cutaneous melanoma in which systemic anti-cancer therapy was compared with placebo or supportive care.
  
  
  METHODS
  Study selection was performed by two independent reviewers. Data extraction forms were used for studies which appeared to meet the selection criteria and, where appropriate, full text articles were retrieved and reviewed independently.
  
  
  RESULTS
  No randomised controlled trials were found comparing a systemic therapy with placebo or best supportive care in metastatic cutaneous melanoma.
  
  
  CONCLUSIONS
  There is no evidence from randomised controlled clinical trials to show superiority of systemic therapy over best supportive care / placebo in the treatment of malignant cutaneous melanoma. Given that patients with metastatic melanoma frequently receive systemic therapy, it is our pragmatic view that a future systematic review could compare any systemic treatment, or combination of treatments, to single agent dacarbazine.
authors.affiliation: Clinical Oncology, Velindre Hospital, Whitchurch, Cardiff, UK, CF4 7XL. tom.crosby@velindre-tr.wales.nhs.uk
authors.forename: T
authors.initials: T
authors.lastname: Crosby
authors.forename: R
authors.initials: R
authors.lastname: Fish
authors.forename: B
authors.initials: B
authors.lastname: Coles
authors.forename: M D
authors.initials: MD
authors.lastname: Mason
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents