title: Metastatic melanoma - a review of current and future treatment options.
abstract: Despite advances in treatment and surveillance, melanoma continues to claim approximately 9,000 lives in the US annually (SEER 2013). The National Comprehensive Cancer Network currently recommends ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma. Little data exists to guide management of cutaneous and subcutaneous metastases despite the fact that they are relatively common. Existing options include intralesional Bacillus Calmette-Guérin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation therapy, interferon therapy, and intratumoral interleukin-2 injections. Newly emerging treatments include the anti-programmed cell death 1 receptor agents (nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec). Available treatments for select sites include adoptive T cell therapies and dendritic cell vaccines. In addition to reviewing the above agents and their mechanisms of action, this review will also focus on combination therapy as these strategies have shown promising results in clinical trials for metastatic melanoma treatment.
authors.affiliation: Department of Dermatology, University of California Davis, School of Medicine, 3301 C Street, Suite 1400, Davis, 95816 Sacramento, USA. emaverakis@ucdavis.edu.
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Cornelius
authors.forename: Glen M
authors.initials: GM
authors.lastname: Bowen
authors.forename: Tiffany
authors.initials: T
authors.lastname: Phan
authors.forename: Falin B
authors.initials: FB
authors.lastname: Patel
authors.forename: Sarah
authors.initials: S
authors.lastname: Fitzmaurice
authors.forename: Young
authors.initials: Y
authors.lastname: He
authors.forename: Barbara
authors.initials: B
authors.lastname: Burrall
authors.forename: Christopher
authors.initials: C
authors.lastname: Duong
authors.forename: April M
authors.initials: AM
authors.lastname: Kloxin
authors.forename: Hawa
authors.initials: H
authors.lastname: Sultani
authors.forename: Reason
authors.initials: R
authors.lastname: Wilken
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Forum
authors.initials: F
authors.lastname: Patel
mesh_terms: D001688:Biological Products / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000627:therapeutic use; D017321:Clinical Trials, Phase I as Topic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D015552:Injections, Intralesional; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D015580:Mohs Surgery / Q000379:methods; D058990:Molecular Targeted Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D018426:SEER Program; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D019496:Cancer Vaccines; D007372:Interferons