title: [Therapy of malignant melanoma at the stage of distant metastasis].
abstract: Treatment of melanoma in the stage of distant metastasis aims on palliation and achievement of durable tumor remission with prolongation of survival. As long as metastasis is confined to one organ system and is removable, surgery remains the treatment of first choice. In limited metastasis radiotherapy may likewise be indicated, particularly in bone and brain metastasis. More extensive metastasis should be treated by chemotherapy or chemoimmunotherapy. Monochemotherapy with dacarbazine, temozolomide, fotemustine and vindesine or its combinations with interferon-alpha are currently preferred. Polychemotherapy or its combinations with interferon-alpha and interleukin-2 are suitable to produce higher response rates but failed to prolong survival. As these treatments are associated with substantially higher toxicity they have been widely abandoned. Combined treatment with dacarbazine and interferon-alpha obtain tumor responses or stable disease in 40-50% and objective tumor remissions in 15-20% of patients. Effective cancer vaccination strategies and blockade of melanoma specific target molecules are currently developed as new treatment options.
authors.affiliation: Sektion Dermatologische Onkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen. claus.garbe@med.uni-tuebingen.de
authors.forename: C
authors.initials: C
authors.lastname: Garbe
authors.forename: T K
authors.initials: TK
authors.lastname: Eigentler
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D007376:Interleukin-2 / Q000008:administration & dosage / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D009362:Neoplasm Metastasis; D009607:Nitrosourea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D010166:Palliative Care; D011379:Prognosis; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012878:Skin Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D000077204:Temozolomide; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014751:Vindesine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D016898:Interferon-alpha; D007376:Interleukin-2; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; D003606:Dacarbazine; C054368:fotemustine; D014751:Vindesine; D000077204:Temozolomide