New Treatments for Melanoma

Marie-France Demierre; Sandy Allten; Rebecca Brown

Disclosures

Dermatology Nursing. 2005;17(4):287-295. 

In This Article

Abstract and Introduction

The different melanoma vaccines under investigation in multicenter phase III trials are reviewed and the concept of chemoprevention in melanoma is discussed. A retrospective review of the literature is presented. Studies included those ongoing or recently published phase III melanoma vaccine trials and current data on chemoprevention of melanoma. The referenced study designs and methodologies varied. Vaccine therapy of melanoma remains promising, given the associated low toxicity. Chemoprevention of melanoma is an unexplored and promising strategy. Well-designed trials in high-risk individuals, incorporating intermediate biologic endpoints, are necessary.

Cutaneous melanoma is one of the most rapidly increasing cancers in the United States (Jemal, Devesa, Hartge, & Tucker, 2001). Not only have the incidence and mortality continued to increase (Geller et al., 2002), but melanoma remains a malignancy predominantly refractory to anti-cancer therapies. New strategies are urgently needed, particularly as it has been predicted that growth and aging of the U.S. population could potentially double the cancer burden in the next 50 years (Edwards et al., 2002).

The occasional dramatic re sponse of patients with metastatic melanoma to vaccination with allogeneic or autologous tumor preparations or antigenic proteins or protein fragments (peptides), has spurred extensive efforts to develop melanoma vaccines. Multicenter phase III adjuvant vaccine therapy studies are evaluating multiple different vaccines in several different clinical settings (see Table 1 ). Because vaccines have relatively lower toxicity and potential benefit, positive studies could dramatically affect standard clinical practice and ultimately open new avenues for disease prevention. Among prevention strategies, the concept of chemoprevention has generated the most interest (Demierre & Nathanson, 2003). Chemo pre vention, a potentially powerful approach to controlling melanoma, is based on the principles that ultraviolet-induced melanoma is a multistep process, and that molecular events and pathways associated with these steps can be targeted (Demierre & Merlino, 2004). Since dermatology and oncology nurses and dermatologists are centrally involved in the care of patients with melanoma, ongoing phase III vaccine trials and their specific dermatologic considerations are reviewed (see Table 2 & Table 3 ). Chemopre vention, a strategy under investigation in several malignancies, is discussed in the context of melanoma.

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