title: Current systemic therapies for melanoma.
abstract: BACKGROUND
  Systemic agents are used in melanoma for adjuvant therapy and to treat metastatic disease. Currently, interferon-α is the only agent approved for adjuvant therapy. Six drugs are FDA approved for metastatic disease: dacarbazine, interleukin-2 (IL-2), vemurafenib, ipilimumab, dabrafenib, and trametinib. Vemurafenib and ipilimumab were approved in 2011, whereas dabrafenib and trametinib were approved in 2013.
  
  
  OBJECTIVE
  This review will update the practicing dermatologist on the differences in efficacy, adverse events, and cost of systemic therapies available for the treatment of melanoma.
  
  
  METHODS
  This article is a review of the current literature on systemic therapies for advanced melanoma. Key search words included "advanced melanoma," "systemic therapy," and "adjuvant therapy" with particular focus on the past 20 years.
  
  
  RESULTS
  Before 2011, dacarbazine and IL-2 were the only FDA approved therapies for metastatic melanoma, and IFN-α is the only approved agent for adjuvant therapy. The new agents vemurafenib, ipilimumab, dabrafenib, and trametinib are the first to have improved overall survival in Phase III studies in comparison with other systemic therapies.
  
  
  CONCLUSIONS
  Despite new developments, there remains a significant need for better therapies with improved long-term efficacy and decreased toxicity.
authors: *School of Medicine, Case Western Reserve University, Cleveland, Ohio; †Department of Hematology and Oncology, Seidman Cancer Center, University Hospitals Case Medical Center and School of Medicine, Cleveland, Ohio; ‡Department of Dermatology, University Hospitals Case Medical Center and School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors: Darren M
authors: DM
authors: Palathinkal
authors: Timmie R
authors: TR
authors: Sharma
authors: Henry B
authors: HB
authors: Koon
authors: Jeremy S
authors: JS
authors: Bordeaux
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007211:Indoles / Q000627:therapeutic use; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D007376:Interleukin-2 / Q000009:adverse effects / Q000627:therapeutic use*; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D010091:Oximes / Q000627:therapeutic use; D017671:Platinum Compounds / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use; D011744:Pyrimidinones / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013449:Sulfonamides / Q000627:therapeutic use; D043823:Taxoids / Q000627:therapeutic use; D000077204:Temozolomide; D000077484:Vemurafenib
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D007093:Imidazoles; D007211:Indoles; D016898:Interferon-alpha; D007376:Interleukin-2; D000074324:Ipilimumab; D010091:Oximes; D017671:Platinum Compounds; D047428:Protein Kinase Inhibitors; D011728:Pyridones; D011744:Pyrimidinones; D013449:Sulfonamides; D043823:Taxoids; C080625:taxane; D000077484:Vemurafenib; C560077:trametinib; D003606:Dacarbazine; C561627:dabrafenib; D000077204:Temozolomide