What is the role of systemic chemotherapy in the treatment of choroidal melanoma?

Updated: Dec 12, 2018
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Although undetected metastatic spread at the time of diagnosis and treatment of choroidal melanoma is a major concern in every patient, adjuvant systemic treatment is not advocated. This consensus comes from treatment trials with intraocular melanomas and extrapolation of the experience with cutaneous melanoma, where adjuvant treatment has shown no benefit.

When distant metastases are found during the initial systemic workup, treatment of the intraocular melanoma itself becomes palliative. Prior to 2011, systemic chemotherapy was the primary treatment for metastatic malignant melanoma discovered either at the initial workup or later in the disease course. Traditional chemotherapy types are no longer used as first-line therapy. Agents previously used individually or in combination included dacarbazine, temozolomide, cisplatin, fotemustine, lomustine, the taxanes, and vinblastine. Unfortunately, these approaches have had only minimal success in improving overall survival.


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