Treatments for melanoma (an aggressive type of skin cancer) that has spread to other tissues.

Crosby T, Fish R, Coles B, Mason M

Published Online:

July 8, 2009

There are no randomised trials comparing the effects of systemic therapies for metastatic cutaneous melanoma with best supportive care or placebo. Cutaneous melanoma is the most aggressive form of skin cancer. When it has spread (metastatic cutaneous melanoma), the prognosis is very poor. Current practice, based upon the results of non comparative studies, is to use different forms of chemotherapy (anti cancer drugs) as well as drugs that try to affect the immune system's response to the cancer. Combinations of these two types of therapy have improved the outcome in some forms of cancers, and are used for melanoma. However the review found no trials which compared the outcome of treatments, used alone or in combination, with the outcome of best supportive care or placebo.

Abstract (click to read)

Background:

Systemic therapies for metastatic cutaneous melanoma, the most aggressive of all skin cancers, remain disappointing. Few lasting remissions are achieved and the therapeutic aim remains one of palliation.

Many agents are used alone or in combination with varying degrees of toxicity and cost. It is unclear whether evidence exists to support these complex regimens over best supportive care / placebo.

Objectives:

To review the benefits from the use of systemic therapies in metastatic cutaneous melanoma compared to best supportive care/placebo, and to establish whether a 'standard' therapy exists which is superior to other treatments.

Search strategy:

Randomised controlled trials were identified from the MEDLINE, EMBASE and CCTR/CENTRAL databases. References, conference proceedings, and Science Citation Index/Scisearch were also used to locate trials. Cancer registries and trialists were also contacted.

Selection criteria:

Randomised controlled trials of adults with histologically proven metastatic cutaneous melanoma in which systemic anti-cancer therapy was compared with placebo or supportive care.

Data collection and analysis:

Study selection was performed by two independent reviewers. Data extraction forms were used for studies which appeared to meet the selection criteria and, where appropriate, full text articles were retrieved and reviewed independently.

Main results:

No randomised controlled trials were found comparing a systemic therapy with placebo or best supportive care in metastatic cutaneous melanoma.

Authors' conclusions:

There is no evidence from randomised controlled clinical trials to show superiority of systemic therapy over best supportive care / placebo in the treatment of malignant cutaneous melanoma.
Given that patients with metastatic melanoma frequently receive systemic therapy, it is our pragmatic view that a future systematic review could compare any systemic treatment, or combination of treatments, to single agent dacarbazine.

This record should be cited as:

Crosby T, Fish R, Coles B, Mason M. Systemic treatments for metastatic cutaneous melanoma. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD001215. DOI: 10.1002/14651858.CD001215

Assessed as up to date:

February 22, 2000

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Primary Review Group:

Skin Group

Health topics:

Cancer > Skin > Malignant melanoma

Skin > Tumours & cysts > Malignant melanoma

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Treatments for melanoma (an aggressive type of skin cancer) that has spread to other tissues.

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