Zusammenfassung
Das maligne Melanom stellt nach wie vor eine große therapeutische Herausforderung
für Onkologen und Dermatologen dar. Auf 100 000 Einwohner in Europa kommen jährlich
10 neu diagnostizierte Melanomerkrankungen. Nur durch eine frühe Diagnose und adäquate
chirurgische Exzision kann eine Metastasierung des Tumors verhindert werden. Bei ungefähr
20 % der Patienten führt die Erkrankung zur Metastasierung und zum Tod, denn im Stadium
IV der Erkrankung gibt es keine kurative Behandlung. Keine der bisher durchgeführten
Studien konnte eine therapeutische Überlegenheit einer Polychemotherapie und/oder
einer Kombination mit Zytokinen gegenüber einer Monochemotherapie mit DTIC allein
belegen. Somit bleibt DTIC der Standard in der Melanomtherapie, sowohl was Effektivität
als auch Nebenwirkungsspektrum und Lebensqualität betrifft.
Abstract
Melanoma continues to present a major therapeutic challenge to oncologists, and dermatologists.
Ten melanomas per 100 000 inhabitants are newly diagnosed per year in Europe. Only
early detection and adequate surgical excision of the primary tumor will prevent metastatic
dissemination. Around 20 % of affected patients will eventually metastasize and die
of melanoma. No effective curative treatment ia available in stage IV of this disease.
Polychemotherapy and/or combination with cytokines did not demonstrate superiority
to single-agent DTIC which is still considered standard treatment in Europe.
Literatur
1
Ahmann D L. et al .
Complete responses and long-term survivals after systemic chemotherapy for patients
with advanced melanoma.
Cancer.
1989;
63
224-227
2
Helmbach H. et al .
Drug-resistance in human melanoma.
Int J Cancer.
2001;
93
617-622
3 Crosby T. et al .
Systemic treatments for metastatic cutaneous melanoma (Cochrane Review). In: The Cochrane Library, 4. Oxford; Update Software 2001
4
Wittes R E. et al .
Combination chemotherapy in metastatic malignant melanoma: a randomized study of three
DTIC-containing combinations.
Cancer.
1978;
41
415-421
5
Costanzi J J. et al .
Combination chemotherapy plus BCG in the treatment of disseminated malignant melanoma:
a Southwest Oncology Group Study.
Med Pediatr Oncol.
1982;
10
251-258
6
Jungelius U. et al .
Dacarbazine-vindesine versus dacarbazine-vindesine-cisplatin in disseminated malignant
melanoma. A randomised phase III trial.
Eur J Cancer.
1998;
34
1368-1374
7
Luikart S D. et al .
Randomized phase III trial of vinblastine, bleomycin, and cis-dichlorodiammine-platinum
versus dacarbazine in malignant melanoma.
J Clin Oncol.
1984;
2
164-168
8
Ringborg U. et al .
Dacarbazine versus dacarbazine-vindesine in disseminated malignant melanoma: a randomized
phase II study.
Med Oncol Tumor Pharmacother.
1989;
6
285-289
9
Charion-Sileni V. et al .
Phase II randomized study of dacarbazine, carmustine, cisplatin and tamoxifen versus
dacarbazine alone in advanced melanoma patients.
Melanoma Res.
2001;
11
189-196
10
Chapman P B. et al .
Phase III multicenter randomized trial of the Dartmouth regimen versus dacarbazine
in patients with metastatic melanoma.
J Clin Oncol.
1999;
17
2745-2751
11 Middleton M R. 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 - 166. Erratum in: J Clin Oncol 2000; 18 : 2351. Comment in: J Clin
Oncol 2000; 18: 2185.
12
Cocconi G. et al .
Treatment of metastatic malignant melanoma with dacarbazine plus tamoxifen. N Engl
J Med 1992; 327 : 516 - 523. Comment in: N Engl J Med 1992; 327 : 560 - 561.
N Engl J Med.
1993;
328
140-141
13 Rusthoven J J. et al .Randomized, double-blind, placebo-controlled trial comparing
the response rates of carmustine, dacarbazine, and cisplatin with and without tamoxifen
in patients with metastatic melanoma. National Cancer Institute of Canada Clinical
Trials Group. J Clin Oncol. 1996; 14 : 2083 - 2090.
14
Falkson C I. et al .
Phase III trial of dacarbazine versus dacarbazine with interferon alpha-2b versus
dacarbazine with tamoxifen versus dacarbazine with interferon alpha-2b and tamoxifen
in patients with metastatic malignant melanoma: an Eastern Cooperative Oncology Group
study.
J Clin Oncol.
1998;
16
1743-1751
15
Agarwala S S. et al .
A phase III randomized trial of dacarbazine and carboplatin with and without tamoxifen
in the treatment of patients with metastatic melanoma.
Cancer.
1999;
85
979-1984
16
Creagan E T. 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
1884-1890
17
Falkson C I. et al .
Improved results with the addition of interferon alfa-2b to dacarbazine in the treatment
of patients with metastatic malignant melanoma.
J Clin Oncol.
1991;
9
1403-1408
18
Thomson D B. et al .
Interferon-alpha 2a does not improve response or survival when combined with dacarbazine
in metastatic malignant melanoma: results of a multi-institutional Australian randomized
trial.
Melanoma Res.
1993;
3
33-138
19
Bajetta E. et al .
Multicenter randomized trial of dacarbazine alone or in combination with two different
doses and schedules of interferon alfa-2a in the treatment of advanced melanoma.
J Clin Oncol.
1994;
12
806-811
20
Sparano J A. et al .
Randomized phase III trial of treatment with highdose interleukin-2 either alone or
in combination with interferon alfa-2a in patients with advanced melanoma.
J Clin Oncol.
1993;
11
1969-1977
21
Dorval T. et al .
Randomized trial of treatment with cisplatin and interleukin-2 either alone or in
combination with interferon-alpha-2a in patients with metastatic melanoma: a Federation
Nationale des Centres de Lutte Contre le Cancer Multicenter, parallel study.
Cancer.
1999;
85
060-1066
22
Keilholz U. et al .
Interferon alfa-2a and interleukin-2 with or without cisplatin in metastatic melanoma:
a randomized trial of the European Organization for Research and Treatment of Cancer
Melanoma Cooperative Group.
J Clin Oncol.
1997;
15
2579-2588
23
Rosenberg S A. et al .
Prospective randomized trial of the treatment of patients with metastatic melanoma
using chemotherapy with cisplatin, dacarbazine, and tamoxifen alone or in combination
with interleukin-2 and interferon alfa-2b.
J Clin Oncol.
1999;
17
968-975
24
Hauschild A. et al .
Dacarbazine and interferon alpha with or without interleukin 2 in metastatic melanoma:
a randomized phase III multicentre trial of the Dermatologic Cooperative Oncology
Group (DeCOG).
Brit J Cancer.
2001;
84
1036-1042
25
Huncharek M. et al .
Single-agent DTIC versus combination chemotherapy with or without immunotherapy in
metastatic melanoma: a meta-analysis of 3273 patients from 20 randomized trials.
Melanoma Res.
2001;
11
75-81
Prof. Dr. D. Schadendorf
Klinische Kooperationseinheit für Dermatoonkologie (DKFZ) an der Klinik für Dermatologie,
Venerologie und Allergologie des Universitätsklinikums Mannheim
Theodor-Kutzer-Ufer 1 · 68135 Mannheim