Adjuvant therapy

Pegylated Interferon α-2b 6 ug/kg/wk sc x 8 wks, then 3 ug/kg/wk sc, for a total of 5 years

Eggermont AM et al. EORTC 18991: Long-term adjuvant pegylated interferon-alpha2b (PEG-IFN) compared to observation in resected stage III melanoma, final results of a randomized phase III trial.  2007 ASCO annual meeting. Abstract 8504 (link to the abstract).

Interferon α-2b
Interferon α-2b 20 MU/m2/d iv x 5/w for 4 wks, then 10 MU/m2/d sc x 3/w for 48 wks

Kirkwood JM et al. Interferon alfa-2b adjuvant therapy of high risk resected cutaneous melanoma: the Eastern Cooperative Oncology Trial EST 1684. J Clin Oncol 1996; 14:7 (link to the article).

Interferon α-2b
Interferon α-2b 15 MU/m2/d iv x 5/w for 4 weeks.

Gogas H et al. A randomized phase III trial of 1 month versus 1 year adjuvant high-dose interferon alfa-2b in patients with resected high risk melanoma. 2007 ASCO annual meeting. Abstract 8505 (link to the abstract).
 

Metastatic cancer

High-dose Interleukin-2
Interleukin-2 (IL-2) 600,000-720,000 U/kg iv over 15 min q8h for up to 14 doses in 5 days, repeat the treatment after 1-2 weeks of rest (one course). Courses repeated every 6-12 weeks

Tarhini AA et al. Durable complete responses with high-dose bolus interleukin-2 in patients with metastatic melanoma who have experienced progression after biochemotherapy. J Clin Oncol 2007; 25:3802 (link to the article). 

Atkins MB et al. High-dose recombinant interluekin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol 1999; 17:2105 (link to the article).

Dacarbazine (DTIC)
Dacarbazine (DTIC) 250 mg/m2/d iv d1-5
Q3w

Middleton, MR et al. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol 2000; 18:158 (link to the article).

Temozolomide
Temozolomide (Temodar) 200 mg/m2/d po d1-5
Q4w

Middleton, MR et al. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol 2000; 18:158 (link to the article).

Fotemustine
Fotemustine 100 mg/m2 iv over 1 hr qw x 3 wks followed by a 5-week rest, then 100 mg/m2 iv q3w

Avril MF et al. Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study. J Clin  Oncol 2004; 22:1118 (link to the article).

Temozolomide + Thalidomide
Temozolomide (Temodar) 75 mg/m2 po qd x 6 wks every 8 wks
Thalidomide (Thalomid) 100-400 mg po qd

Hwu WJ et al. Phase II study of temozolomide plus thalidomide for the treatment of metastatic melanoma. J Clin Oncol 2003; 21:3351 (link to the article).

Temozolomide + IFN
Temozolomide (Temodar) 200 mg/m2/d po d1-5 q4w
Interferon α-2b 5 MU/m2 sc tiw

Kaufmann R et al. Temozolomide in combination with interferon-alfa versus temozolomide alone in patients with advanced metastatic melanoma: a randomized, phase III, multicenter study from the Dermatologic Cooperative Oncology Group. J Clin Oncol 2005; 23:9001 (link to the article).

Temozolomide + IL-2 + IFN + GM-CSF
Temozolomide (Temodar) 150-200 mg/m2/d po d1-5
IL-2 4 MU/m2/d sc d6-17
Interferon α-2b 5 MU/d sc d6-17
GM-CSF 125 mcg/m2/d (max 250 mcg/d) sc d6-17
Q4w

Robert WW et al. Low-dose outpatient chemobiotherapy with temozolomide, granulocyte-macrophage colony stimulating factor, interferon- α-2b, and recombinant interleukin-2 for the treatment of metastatic melanoma. J Clin Oncol 2005; 23:8992 (link to the article).

Dacarbazine + Cisplatin + Carmustine
Dacarbazine (DTIC) 220 mg/m2/d iv over 1 hr d1-3 q3w
Cisplatin (CDDP) 25 mg/m2/d iv over 30 min d1-3 q3w
Carmustine (BCNU) 150 mg/m2 iv over 2 hrs d1 q6w

Creagan ET et al. Phase III clinical trial of the combination of cisplatin, dacarbazine, and carmustine with or  without tamoxifen in patients with advanced malignant melanoma. J Clin Oncol 1999; 17:1884 (link to the article).

CVD
Cisplatin (CDDP) 20 mg/m2/d iv d1-4 and 22-25
Vinblastine 2 mg/m2/d iv d1-4 and 22-25
Dacarbazine (DTIC) 800 mg/m2 iv d1, 22
Q6w

Eton, O et al. Sequential biochemotherapy versus chemotherapy for metastatic melanoma: results from a phase III randomized trial. J Clin Oncol 2002; 20:2045 (link to the article).

CVD + IL-2 + IFN
Cisplatin (CDDP) 20 mg/m2/d iv d1-4 and 22-25
Vinblastine 1.5 mg/m2/d iv d1-4 and 22-25
Dacarbazine (DTIC) 800 mg/m2 iv d1, 22
IL-2 9 MU/m2/d civi d5-8, 17-20, 26-29
Interferon α-2b 5 MU/m2/d sc d5-9, 17-21, 26-30
Q6w

Eton, O et al. Sequential biochemotherapy versus chemotherapy for metastatic melanoma: results from a phase III randomized trial. J Clin Oncol 2002; 20:2045 (link to the article).

Oblimersen + Dacarbazine
Oblimersen  7 mg/kg/d civi d1-5
Dacarbazine (DTIC) 1000 mg/m2 iv over 1 h d6
Q3w x 8 cycles

Bedikian A et al. Bcl-2 antisense (oblimersen sodium) plus dacarbazine in patients with advanced melanoma: The Oblimersen Melanoma Study Group. J Clin Oncol 2006; 24:4738 (link to the article).