Improving outcomes in advanced malignant melanoma: update on systemic therapy.

Malignant melanoma continues to increase in incidence throughout the developed world. Surgery remains the cornerstone of curative treatment and the use of adjuvant systemic therapy has provoked much debate. Metastatic disease is incurable in most patients. While combination chemotherapy or biochemotherapy may be considered in certain circumstances, it is now clear that single-agent chemotherapy remains the mainstay of treatment for the majority of patients.A number of new agents and novel approaches are under evaluation and show promise. The pro-apoptotic agent oblimersen has shown improved progression-free survival and response rate, although not overall survival, when combined with dacarbazine compared with dacarbazine alone. The BRaf inhibitor sorafenib (BAY 43-9006) has produced encouraging results when administered with chemotherapy and is now being assessed in randomised studies. Thalidomide in combination with chemotherapy is well tolerated and shows a trend towards increased clinical efficacy compared with chemotherapy alone. Other anti-angiogenic drugs, such as bevacizumab, are being investigated in trials. Results with tumour vaccines have been mixed and several large trials are ongoing. This paper discusses recent pivotal studies and promising new agents in systemic therapy for advanced malignant melanoma.