The treatment of disseminated malignant melanoma with special reference to the role of interferons, vinca alkaloids and tamoxifen

Malignant melanoma continues to increase in incidence. While early melanoma is highly curable by surgical means, the prognosis of patients with more advanced lesions and/or metastatic disease remains poor. Conventional chemotherapy with dacarbazine has a low frequency and short duration of response. Alternative drugs with single-agent activity include vinca alkaloids, nitrosoureas, procarbazine and platinum compounds. The addition of tamoxifen to chemotherapy, particularly cisplatin-based chemotherapy, appears to be beneficial. Recent studies suggest that combination chemotherapy may give better outcomes than single-agent treatment. Significant clinical activity has also been demonstrated with the use of interferons, particularly interferon α, and also with IL-2. Two recent studies suggest that the addition of interferon to chemotherapy may be beneficial. In addition, specific active immunotherapy with tumour vaccines has shown promise. The optimal methods of combining these treatment methods, such as chemotherapy and biological response modifiers/immunotherapy, however, remain to be defined.