title: Evidence-based and interdisciplinary consensus-based German guidelines: systemic medical treatment of melanoma in the adjuvant and palliative setting.
abstract: Systemic medical treatment of melanoma is administered in the adjuvant and palliative setting. Adjuvant therapy may be considered in patients with primary melanoma with more than 1.5 mm tumor thickness and with regional node metastasis. Presently no indication for systemic adjuvant chemotherapy or for adjuvant therapy with nonspecific immune-stimulatory agents outside controlled studies is seen. Interferon-alpha is the first substance in the adjuvant therapy of melanoma, which has shown to present a significant advantage to the patients in some prospective randomized studies. Good arguments for using adjuvant interferon-alpha therapy in high-risk melanoma patients exist. Both high-dose and low-dose interferon-alpha show promise. The major indications for systemic chemotherapy and chemoimmunotherapy are inoperable recurrent tumors, inoperable regional metastases and distant metastases (stage IV). As treatment in such situations is primarily palliative, the effect of any regimen on the quality of life must be carefully weighed. As a first line treatment, single agent therapy is recommended, as polychemotherapy or biochemotherapy did not show significant advantages for prolongation of survival; hence they are more toxic. An urgent need for development of new treatment modalities is necessary and general principles of experimental immunotherapy are outlined.
authors.affiliation: University Department of Dermatology, Tübingen, Germany. claus.garbe@med.uni-tuebingen.de
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.forename: Axel
authors.initials: A
authors.lastname: Hauschild
authors.forename: Matthias
authors.initials: M
authors.lastname: Volkenandt
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Stolz
authors.forename: Uwe
authors.initials: U
authors.lastname: Reinhold
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Kettelhack
authors.forename: Bernhard
authors.initials: B
authors.lastname: Frerich
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keilholz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dummer
authors.forename: Günther
authors.initials: G
authors.lastname: Sebastian
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tilgen
authors.forename: Gerold
authors.initials: G
authors.lastname: Schuler
authors.forename: Andreas
authors.initials: A
authors.lastname: Mackensen
authors.forename: Roland
authors.initials: R
authors.lastname: Kaufmann
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016207:Cytokines / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D007167:Immunotherapy; D016898:Interferon-alpha / Q000627:therapeutic use; D008545:Melanoma / Q000188:drug therapy / Q000556:secondary / Q000628:therapy*; D010166:Palliative Care; D011788:Quality of Life; D012878:Skin Neoplasms / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D016207:Cytokines; D016898:Interferon-alpha