Biochemotherapy for the Treatment of Metastatic Malignant Melanoma: A Clinical Practice Guideline

Abstract

Questions What is the role of biochemotherapy in the treatment of metastatic malignant melanoma? For the purposes of this report, “biochemotherapy” is defined as a therapeutic regimen that includes, at a minimum, chemotherapy (either single agent or combination) and interleukin-2. What are the adverse effects and effects on quality of life using biochemotherapy as a treatment option? Perspectives While early detection, appropriate surgery and, in some cases, adjuvant therapy have improved outcomes, at least one third of patients with early-stage melanoma will develop metastases. Recently, in an effort to potentially maximize outcomes, the combination of chemotherapy and immunotherapy (biochemotherapy) has been evaluated The level of interest that this approach has generated, particularly with reference to the apparently high response rates seen in this otherwise devastating illness, was sufficient to merit closer examination of this approach by the Melanoma Disease Site Group (DSG) of Cancer Care Ontario’s Program in Evidence-based Care (PEBC). Outcomes Outcomes of interest include response rate, disease-free survival, overall survival, quality of life, and incidence of grade 3 and 4 toxicities. Methodology Evidence was selected and reviewed by three members of the Program in Evidence-based Care Melanoma Disease Site Group (DSG) and by two methodologists. The present practice guideline report has been reviewed and approved by the Melanoma DSG, compromised of medical and radiation oncologists, surgeons and dermatologists. External review by Ontario practitioners was obtained through a mailed survey, the results of which were incorporated into the practice guideline. Final approval of the original guideline report was obtained from the Program in Evidence-based Care Report Approval Panel (RAP). Results Clinical recommendations were drafted, based on the evidence identified through a systematic review. This practice guideline report with draft recommendations was mailed to Ontario practitioners for external review and to the Report Approval Panel, Feedback from both groups were incorporated into this report to create the final practice guideline. Practice Guideline The recommendations apply to adult patients with metastatic malignant melanoma. Due to the inconsistent results of the available studies with regard to benefit (response, time-to-progression, and survival) and consistently high toxicity rates, biochemotherapy is not recommended for the treatment of metastatic melanoma.