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, Abraxane has fewer side effects and does not require premedication. Abraxane may deliver a higher concentration of active drug to tumors than conventional paclitaxel.Abraxane has a 27% partial response rate in patients with chemotherapy naïve metastatic melanoma. 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.
Taxol also has activity. There are a number of phase II studies suggesting that it is active in melanoma. and was recently studied in combination with carboplatin. There are no phase III studies but the evidence is sound and, unless plan language specifically disqualifies phase II evidence, it should not be considered experimental.
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