Benefits of Chemotherapy. About 20% of cancers shrink in response to one or more of these drugs, but the effects last only between 3 and 6 months. If the tumors completely disappear, the cancer may stay in remission much longer, but in virtually all cases it returns.
Chemotherapeutic Regional PerfusionChemotherapeutic regional perfusion (also called isolated limb perfusion) allows the administration of very high-dose chemotherapy. It is often used effectively for metastasized or recurrent melanoma that occurs on the arm or leg. (It does not appear to be useful for preventing metastasis after a first occurrence of melanoma in one of these locations.) This technique involves the following:
Other treatments being explored include combinations of melphalan with immunotherapy drugs, notably interferon and tumor necrosis factor. Complete response rates as high as 90% have been reported in some patients, but more research is needed to verify the safety and effectiveness of this treatment. In addition to arms and legs, perfusion techniques have been tested for the pelvis, head, neck, skin of the breast, and even the abdomen. |
Immunotherapy
Immunotherapy uses drugs to boost the patient's own immune system. This treatment was developed after experts observed that in some melanoma patients, the tumor temporarily stopped growing and shrank, apparently in response to a very effective natural immune response. This phenomenon is very rare, though it appears more often in melanoma than in other cancers. Adjuvant immunotherapy (used after surgery) is proving to be helpful in melanoma patients at high risk of recurrence.
Cytokines. Specific powerful immune factors called cytokines, particularly those known as interferons, are being used to develop therapies for metastatic melanoma. These agents are typically administered with chemotherapy agents, with other immunotherapies, or both. (If cytokines are prescribed as single-agent therapy they are ineffective at lower doses while at higher, effective doses they become very toxic.) The results of one 2002 report, for example, reported that adding interferons and interleukins to chemotherapy doubled the 5-year survival for advanced melanoma, from 5 - 10%. Side effects are greater with this approach, but they are manageable. A number of other cytokines and combinations are being investigated.
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