STRATEGIES FOR IMPROVING SURVIVAL IN MALIGNANT-MELANOMA - FOCUS ON VINDESINE

This paper summarises the systemic treatments used for metastatic mela noma in the Melanoma Unit at Charing Cross Hospital, UK, and offers an appraisal of adjuvant therapy with special emphasis on recent reports in the literature. Since 1977, patients presenting to this service wi th metastatic disease have been treated with protocols based primarily on vindesine as a single agent or in combinations with dacarbazine, p latinum derivatives and fotemustine. Observed response rates ranged be tween 20% and 30% with the median duration of response not exceeding o ne year. Although the response rates ore not much higher with combinat ion regimens than monotherapy, large tumour volumes involving multiple organ sites ore more likely to regress with polychemotherapy than sin gle-agent treatment. Among 240 patients with widespread metastatic dis ease treated by these different vindesine-containing chemotherapy prot ocols and evaluated for survival, 36 (15%) survived longer than two ye ars from onset of treatment Included among these long-term survivors w ere Patients with hepatic and cerebral metastases. Encouraging though they may be, these results emphasise the need for adjuvant treatment i n critical stages in the evolution of malignant melanoma. In the setti ng of clinical and histological metastases in the regional lymph nodes , adjuvant vindesine has been shown to result in a survival advantage. This and other studies are reviewed.