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10th
International Inter University Scientific Meeting
Academy of Studenica
PERSPECTIVES
IN MELANOMA MANAGEMENT
& NANOTECHNOLOGY IN BIOMEDICINE
Organizers:
Institute of Oncology
Sremska Kamenica; Union of Cancer Prevention
Societies of Vojvodina, Novi Sad; Clinic of Oncology, Nis; Institute
for Oncology and Radiology of Serbia, Belgrade Center for Bioengineering,
Faculty of Mechanical Engineering, University of Belgrade
President:
Vladimir Baltic Vice-presidents: Zlata
Janjic, Radan Dzodic, Borislava Nikolin; Djuro Koruga
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BIOCHEMOTHERAPY
IN TREATMENT OF MELANOMA
Nikolin
B, Salma S, Trifunoviæ J, Baltiæ V.
Institute
of Oncology Sremska Kamenica, Clinic for internal oncology, Sremska
kamenica, Serbia and Montenegro
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ABSTRACT
The
incidence of melanoma is increasing rapidly throughout the world.
It may be related to the reduction in the ozone layer and to increased
exposure to ultraviolet radiation from sunlight. Melanoma is characterized
by a high malignant potential and an outstanding possibility for
giving metastasis. The prognosis of melanoma is directly influenced
by the depth of invasion of the primary lesion and the response
to the initial treatment. If diagnosed early, the majority of primary
melanoma is cured by simple wide surgical excision alone. Once melanoma
has spread, survival drops off precipitously. Thus generated significant
interest in reducing recurrence rates through adjuvant therapies.
Interferon-alfa initiate a complex sequence of intracellular events
such as induction of certain enzymes, suppression of cell proliferation,
immunomodulating activity, inhibition of virus replication in virus
infected cells, inhibition of neoangiogenesis and apoptosis. It
also enhance phagocytic activity of macrophages and augmentate specific
cytotoxicity of lymphocytes for target cells (as natural killer
cells and monocites). Multiple trials involving adjuvant immunotherapy
with interferon-alfa, for the high-risk melanoma patients (tumor
thickness>4mm), showed a significant improvement in disease-free
survival. Unfortunately the question of overall survival remains
contraversial. Treatment of advanced melanoma remains a great challenge.
The limited results observed with chemotherapy and immunotherapy
alone have prompted many investigators empirically to combine chemotherapy
drugs with interferon (IFN) and interleukin-2 (IL-2), referred to
as "biochemotherapy" or "chemoimmunotherapy". One of the most popular
regimens, involved cisplatin, vinblastin and dacarbazine (CVD) chemotherapy
administered concurrently with IL-2 and IFN. Many of these cisplatin-based
biochemotherapy regimens have substantial toxicity. They do produce
a statistically superior response rate (p = 0.04) but there is no
difference in time to progression or overall survival. Biochemotherapy
remains an important treatment modality in young patients with no
central nervous system metastases. Otherwise, experimental agents
should be considered. Considering extremely short overall survival
in stage IV melanoma patients with all the modalities of treatment
to this day, prevention, by sun avoidance, the use of sunscreens
and early recognition of the clinical characteristics for an early
diagnosis and adequate surgical treatment are still the best weapons
against melanoma. |
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Keywords:
Melanoma; Adjuvant immunotherapy; Interferon-alfa; Chemotherapy
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