Metastatic melanoma - a review of current and future treatment options

• Published in: Acta dermato-venereologica Vol. 95; no. 5; pp. 516 - 524
• Main Authors: Maverakis, Emanual, Cornelius, Lynn A, Bowen, Glen M, Phan, Tiffany, Patel, Falin B, Fitzmaurice, Sarah, He, Young, Burrall, Barbara, Duong, Christopher, Kloxin, April M, Sultani, Hawa, Wilken, Reason, Martinez, Steve R, Patel, Forum
• Format: Journal Article
• Language: English
• Published: Sweden 01-01-2015
• Subjects: Biological Products - therapeutic use; Cancer Vaccines - therapeutic use; Clinical Trials, Phase I as Topic; Combined Modality Therapy; Female; Humans; Immunotherapy - methods; Injections, Intralesional; Interferons - therapeutic use; Male; Melanoma - pathology; Melanoma - secondary; Melanoma - therapy; Mohs Surgery - methods; Molecular Targeted Therapy - methods; Neoplasm Invasiveness - pathology; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; SEER Program; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Treatment Outcome
• ISSN: 0001-5555; 1651-2057
• DOI: 10.2340/00015555-2035

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.