What is the role of chemotherapy and immunotherapy in the treatment of head and neck mucosal melanomas?

Updated: May 07, 2020
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Chemotherapy/immunotherapy is usually used with an adjuvant or palliative intention. The most frequently used chemotherapy agents are dacarbazine, the platinum analogues, the nitrosoureas, and the microtubular toxins.

Immunotherapy is currently effective only in a small percentage of patients with malignant melanoma. [9] Increased response rate have been observed when interleukin 2 (IL-2) and interferon-alpha (IFN-a) are used with cisplatin.

In a study of 44 patients with mucosal melanoma, including 18 (40.9%) with lesions of the head and neck, Moya-Plana et al found that in cases of unresectable and/or metastatic disease, immunotherapy with pembrolizumab, a programmed cell death protein 1 (anti-PD-1) inhibitor, had a better benefit-risk ratio than did immune treatment with ipilimumab, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor. First-line immunotherapy with ipilimumab was associated with an objective response rate (ORR) of 8.2%, with one complete response, while first-line treatment with pembrolizumab was associated with an ORR of 35%, with four complete responses. The investigators also found that for first-line treatment with ipilimumab and pembrolizumab, median progression-free survival (PFS) was 3 months and 5 months, respectively. [20]


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