Cancer Treatment Today

Sprycel (dasatinib) is an attractive drug for use in melanoma because it affects mutations that re sometimes expressed in melanoma cells, A recent phase II study (Kluger et al) found that it had minimal activity in melanoma, except in patients with the C-KIT mutations. Thirty-nine patients were enrolled, 36 of whom were evaluable for activity and toxicity. Five, 4, and 3 patients had acral-lentiginous, ocular, or mucosal primaries, respectively.

DecisionDx is a molecular diagnostic test developed at and licensed from The University of Texas M. D. Anderson Cancer Center. The test is used to prospectively predict patient outcome to treatment for various cancers. DecisionDx-UM is a more specific prognostic test that determines the metastatic risk associated with ocular melanoma tumors of the eye. The test classifies tumors as Class 1A (low metastatic risk), Class 1B (long-term metastatic risk),

Metastatic melanoma responds poorly to chemotherapy with the main drugs being temozolomide or dacarbazine after failure of immunotherapy with ipilimumab or vaccination. However, Abraxane has been reported to have single agent activity. This response rate is higher than observed previously with paclitaxel or docetaxel suggesting that this formulation of paclitaxel may be more active than the conventional form. Among the 37 chemotherapy-naive patients,

Zelboraf is anti BRAF kinase inhibitor. ZELBORAF™ is indicated for the treatment of patients with unresectable or metastatic melanoma with BRAFV600E mutation as detected by an FDA-approved test. More than 30 mutations of the BRAF gene associated with human cancers have been identified. The most common one is BRAFE, a substitution of  valine (V)  glutamate (E) at codon 600, and it is referred to as  BRAF600E. Other mutations which have been found

  Ipilimumab(Yervoy) is directed against an antigen on the surface of T cells. It is an FDA approved drug for the treatment of unresectable or metastatic melanoma. Some patients have only a partial response or progress and many physicians would retreat in such a situation. Due to potentially severe or even fatal safety issues, the FDA approved this agent with a Risk Evaluation and Mitigation Strategy (REMS) to ensure the benefits of the agent

The role of PET in melanoma is not fully defined. Medicare currently covers PET for initial staging of melanoma and restaging, although it states, "CMS guidelines state that PET would rarely be used in the diagnosis of melanoma".  CMS does not cover PET for evaluation of regional nodes when there is not suspicion for more extensive disease. NCCN does list PET as a staging option. The most recent review (Petrella et al) concluded: "PET scanning facilitates

The role of PET in staging myeloma not clear. Traditionally, myeloma was staged with IgG levels, bone survey and lab tests. While PET is very sensitive for metastases, it can be falsely positive and is not a good study for nodal staging. Only retrospective analyses are available. However, expert opinion as represented by NCCN does recommend PET as an option for stage I - III disease. For followup surveillance, NCCN added "consider PET" in 2007. "The

Plaque radiotherapy is a different procedure than photocoagulation. Plaque brachytherapy is a widely accepted alternative to enucleation for medium-sized posterior uveal melanomas (<10 mm in height and <15 mm in diameter). The most common material used in modern plaques is iodine 125, because of its lower energy emission (lack of alpha and beta rays), its good tissue penetration, and its commercial availability. Radiation from this source causes

Metastatic melanoma responds poorly to chemotherapy with the main drugs being temozolomide or dacarbazine after failure of immunotherapy or vaccination. However, Abraxane has been reported to have single agent activity suggesting a role for taxanes. Abraxane is an albumin-bound paclitaxel that is approved for the treatment of metastatic breast cancer and is now undergoing clinical trials primarily in diseases known to be taxane sensitive. However,

Metastatic melanoma responds poorly to chemotherapy with the main drugs being temozolomide or dacarbazine after failure of immunotherapy or vaccination. A randomized study suggests that cytokines substantially augment the antitumor activity of chemotherapy at the expense of considerable toxicity in patients with metastatic melanoma. Phase II trials with biochemotherapy (BCT) have shown encouraging response rates in metastatic melanoma, and meta-analyses